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Position Summary
The Population Health (PH) Director is accountable for health care quality projects and initiatives through direction setting and leadership. Assimilates information to proactively develop quality activities aligned with company strategies and values. Links the quality management activities to business goals. Proactively builds strong teams and business relationships, both internally and externally. Serves as a resource and subject matter expert (SME) on aspects of the population health program to develop and influence business strategies. Must reside in Ohio.

• Oversee OhioRISE Plan support of system-wide and MCO population health initiatives based on a deep understanding of scientific population health principles;
• Coordinate with ODM, MCOs, and other state child-serving agencies to design, implement, coordinate, and evaluate population health initiatives focused on the behavioral health of high-risk children and youth;
• Sponsor and champion OhioRISE Plan and system-wide initiatives, including cultivating the support necessary to achieve the desired operational objectives for each initiative;
• Liaison with ODM, MCOs, the SPBM, and other ODM contracted MCOs on population health activities;
• Develop and implement operational plans that address the market opportunities/challenges and align with the established population health goals; and
• Provide leadership for programmatic initiatives to reduce health disparities and address SDOH.
• Makes business decisions based on the results of research and data analysis.
• Has responsibility for decision making regarding the design, development, and implementation strategy of population health projects, and initiatives.
• Manage a Population Health functional department including development and oversight of performance metrics and application of HR policies and procedures.
• Forms and leads cross functional teams to assist business units in integrating quality into their strategic and operational plans.
• Evaluates and prioritizes recommendations for population health activities to senior management and/or customers.
• Manage Value Added Benefits for OhioRISE members and families
• Supports NCQA activities, developing population health strategy and evaluation.
• Develops, implements, and evaluates the organization’s policies and procedures to meet business needs.
• Directs/provides enhancements to business processes, policies and infrastructure to improve operational efficiency across the organization.
• Influences department business owners and leaders to reach solutions to meet the needs of Plan Sponsors, regulators and other customers while meeting departmental objectives.
• Performs strategic analysis of business performance data to address Plan Sponsor needs.
• In partnership with business owners, supports design/ development of new or enhanced products and services.
• Translates knowledge of subject and business needs into clear strategic business plans.
• Serves as a technical, professional and/or business expert that may cross multiple business functions.

Required Qualifications

• 5+ years progressively responsible professional experience in population health, quality management, service coordination, ambulatory care, community public health, case or care management, or coordinating care across multiple settings and with multiple providers.
• Demonstrated leadership ability.
• Specialty experience with children and adolescents with complex behavioral health needs, experience with multi-system involved children and youth, experience with addressing health equity and race equity issues, and understanding of the different systems that serve children and youth.
• Understanding of trends and constituency expectations.

Preferred Qualifications

• Strong knowledge and understanding of Medicaid managed care programs, regulations, and compliance requirements.
• Experience in developing and managing value-added benefits programs, preferably in a Medicaid or managed care setting
• Familiarity with evidence-based practices, interventions, and services for youth with behavioral health needs.
• Knowledge of HIPAA regulations and confidentiality requirements.
• Exceptional communication and interpersonal skills, with the ability to collaborate effectively with a diverse range of stakeholders
• Excellent analytical and problem-solving skills, with the ability to gather and interpret data to inform decision-making

Education Master's degree or other advanced degree in nursing, social work, health services research, health policy, information technology, or other relevant field.

Pay Range

The typical pay range for this role is:

$67,900.00 - $149,328.00

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: 11/30/2024

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