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Position Summary
The OhioRISE (Resilience through Integrated Systems and Excellence) program is a specialized Medicaid managed care initiative focused on providing and coordinating behavioral health services for eligible children and youth. The Manager, UM Clinical Health Services serves as a key Behavioral Health leader within the Aetna Medicaid plan, overseeing utilization management activities. This role is responsible for the oversight, development, and performance of clinical teams, including driving high-quality processes, ensuring compliance, and fostering strong team performance.
This is a full-time, fully remote position. Eligible candidates must reside within the state of Ohio.
Fundamental Components
Reinforces clinical philosophy, programs, policies and procedures.
Communicates strategic plan and specific tactics to meet plan.
Ensures implementation of tactics to meet strategic direction for cost and quality outcomes.
Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results.
Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
Will be accountable for meeting the financial, operational and quality objectives of the unit.
Will be accountable for the day-to-day management of team(s) for appropriate implementation and adherence with established practices, policies and procedures.
Works closely with other functional area managers to ensure consistency in clinical interventions supporting our plan sponsors.
Develop, initiate, monitor and communicate performance expectations.
May act as a single point of contact for the customer and the Account Team which includes participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.
Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills.
Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams.
Consistently demonstrates the ability to serve as a model change agent and lead change efforts.
Accountable for maintaining compliance with policies and procedures and implements them at the employee level.
Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.
Required Qualifications
Ohio resident
Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered Nurse (RN) with unrestricted Ohio state license with psychiatric specialty, certification, or experience
5+ years of clinical practice experience in behavioral healthcare
2+ years utilization management experience is required (preferably in a managed care setting)
2+ years of demonstrated healthcare leadership experience required (preferably in a managed care setting)
2+ years of experience with personal computer, keyboard navigation, and MS Office Suite applications
1+ year(s) of experience with electronic medical records
Must possess reliable transportation and be willing and able to travel in-state up to 10% of the time. Mileage is reimbursed per our company expense reimbursement policy.
Ability to work core business hours, Monday-Friday, 7:30am-5pm EST, with flexibility to work on call occasional weekend hours is required.
Must have high speed internet access
Preferred Qualifications
Managed care/utilization management experience strongly preferred
Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
Medicaid experience
If RN, BSN degree preferred
Education
If Behavioral Health: Master’s degree in a field leading to independent Behavioral Health clinical licensure (LCSW, LPCC, LMFT
If Registered Nurse: Master's degree or equivalent experience in clinical area of expertise (e.g. bachelor's degree plus 7 years' experience; associate's degree or RN diploma plus 9 years' experience).
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$87,035.00 - $187,460.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 03/27/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.