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Position Summary

The OhioRISE (Resilience through Integrated Systems and Excellence) plan is a Medicaid managed care program that provides and coordinates behavioral health care for eligible children and youth. The OhioRISE Director of the Psychiatric Residential Treatment Facility (PRTF) Hub is responsible for the management and oversight of all activities that support PRTF clinical and administrative operations. The director of the PRTF Hub reports to the Children’s System of Care Executive Director and works in close partnership with the CEO, COO, CMO, CFO, Care Coordination Director and other Aetna teams, all matrixed growth partners to effectively support our PRTF implementation and oversight.

 

This is a fully remote position. Eligible candidates can live anywhere in the United States, Ohio resident preferred.

Responsibilities include:

• Supervises PRTF Clinical Administrator and PRTF Administrator on the specific jobs and tasks related to supporting the clinical administration and implementation and oversight of the PRTF Program.
• Leads the overall implementation process of all PRTF programs, quality improvement, PRTF Oversight and reporting, clinical support and integration with Aetna teams, ODM teams, PRTF teams, and other Ohio based teams supporting PRTF programming.
• Coordinates with Director, CME Alliance Hub to ensure continuity of care between CMEs and PRTF providers.
• Leads the Aetna internal implementation process for all PRTF Programming.
• Supports the PRTF contracting process with Provider Relations and Contracting.
• Maintains the PRTF Manual content and updates.
• Coordinates training needs with Aetna Training Manager and Education and Learning Alliance with ODM.

Minimum Requirements

• Five years management experience
• Five or more years of experience in public sector, managed behavioral health care.
• Knowledge and understanding of the Ohio Medicaid managed care market and familiarity with PRTF and residential treatment.
• Experience with relevant stakeholders including the Ohio Department for Medicaid and the Ohio behavioral health provider community.
• Persuasive communication skills, both written and verbal
• Excellent organization and time management skills
• Understanding of system of care process – OMAS, juvenile justice, youth services, developmental disabilities
• Understanding of health plan operations, including contracting, claims processing, encounter data processing, and Medicaid eligibility and enrollment. Experience navigating a matrixed organization.
• Ability to travel to Ohio at least once monthly for visits to PRTFs

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Preferred Requirements

• Ohio resident
• Experience working in congregate setting for 3 or more years
• Clinical degree and experience, i.e. Social Work, Professional Counseling, Marriage and Family

Education Bachelor’s degree in healthcare field, master’s degree preferred

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,540.00

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.  This position also includes an award target in the company’s equity award program. 
 
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

We anticipate the application window for this opening will close on: 01/17/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.