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Position Summary:
The Behavioral Health Navigator is a clinical leader in the Medicaid plan focusing on integrating member care, health clinical coordination, leading the development, implementation and ongoing monitoring of program and quality initiatives to address the needs of Aetna OhioRISE members. They represent the plan and collaborate with State governments, key stakeholders, community organizations, advocacy groups as well as the OhioRISE Medical Director and senior leadership team to enhance the quality of services provided to Aetna members and to ensure adherence to performance targets of the business area.
As part of the bold vision to deliver the “Next Generation” of managed care in Ohio Medicaid, Ohio RISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems.
Fundamental Components:
• Serves as a key resource regarding issues related to the integration of member care across departments.
• Consults with plan leadership regarding behavioral health clinical issues as they relate to provider and system of care issues, behavioral health issues including critical stakeholders such as various departments of state government, provider organizations, advocacy organizations, etc.
• Attend Child and Family Team meetings to support creative problem solving to meet the needs of the youth
• Provides clinical expertise in the interdisciplinary team, with requisite range and depth of subject matter expertise to meet the needs of the covered population.
• Represents Plan to relevant external stakeholders, such as state government officials, providers/vendors, & advocacy groups regarding quality improvement initiatives, integrating member care, health plan success, and innovative care strategies.
• Coordinating the development and submission of any responses for OhioRISE to ODM
• Participate in and support process improvement initiatives within care management and across broader health plan operations.
• Assisting community stakeholders, providers, CMEs, and OhioRISE Care management staff navigating complex challenges.
Required Qualifications:
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Must reside in the State of Ohio
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Active and unrestricted independent licensure in OH - Licensed Behavioral Health Clinician (LISW, LPCC, IMFT), or RN
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5+ years’ experience in a behavioral health clinical setting
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3+ years’ complex behavioral health experience in a managed care, community, or institutional setting for children and youth, and their family/caregivers.
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2+ years’ experience with personal computer, keyboard navigation, including Microsoft Outlook, Microsoft Teams, Microsoft Word and Dynamo or Electronic Medical Records (EMR)
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Willing and able to travel in-state up to 10% of the time with a personal vehicle. Mileage is reimbursed per our company expense reimbursement policy
Preferred Qualifications:
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Experience with, or strong knowledge of the Ohio Multi-System Custody Relinquishment Prevention Program
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Proven communication skills both written and verbal and able to communicate effectively with all levels of an organization from C-Suite executives to front-line staff
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Excellent consultative and communication skills, analytical ability, decisiveness, strong judgment, and the ability to work effectively with clients, staff, and vendors
Education:
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Master’s degree in Social Work, Counseling or Marriage and Family Therapy or RN with associates degree or nursing diploma required
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If RN, BSN degree is preferred
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$72,306.00 - $155,736.00
This 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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)
We anticipate the application window for this opening will close on: 04/03/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
