At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

As the Care Management Entity (CME) Relationship Manager, you will be responsible for ongoing CME relationship management and satisfaction for assigned initiatives that impact the delivery of services to our OhioRISE members in the internal and external environment. Accountable for transferring knowledge, best practices (external and internal), methodology and tools to internal and external partners and organizations. Participates as a team member, representing the Aetna Better Health OhioRISE plan and ensuring compliance with contractual requirements including the exchange of data to ensure appropriate CME oversight. Responsible to ensure communications between CME and Aetna Better Health of Ohio for purposes of streamlining operations, troubleshooting and facilitating Joint Operating Committees.

******* YOU MUST RESIDE IN THE STATE OF OHIO******

Specific Duties include, but are not limited to:

Collaborate with Case Management Entities (CMEs), the Ohio Department of Medicaid (ODM) staff, physical health Managed Care Organizations (MCOs), community partners, and other child-serving external organizations, and care coordination team members and/or matrixed staff as required in support of the OhioRISE program.Support holistic solutions and/or key strategic plans.Proactively and strategically identifies opportunities for improvement within assigned initiatives and CME relationship management.Conduct thorough business case and external customer value analysis to determine selection, prioritization positioning and approach for broadest range of potential solutions (e.g., process improvements, technology solutions).Participate in influencing CME process improvement activities, builds optimal relationships for results and deliverables, and manages relationship throughout engagement.Participate and supports metrics integration and execution for optimal results.Share joint accountability and ensures at a minimum the meeting of contractual requirements and expectations.Communicate compelling and concise results to empower internal/external stakeholders in decision making process regarding opportunities for improvement.Participate in initiative planning as required and supports engagement using a disciplined repeatable methodology.Design, develop interventions, and facilitate work sessions.Develop and deliver all required analysis, reporting and presentation materials.Gather, analyze, and synthesize business intelligence to drive achievement of strategic business objectives.Build and utilize diverse internal and external networks, as appropriate, for data gathering and best practice identification.Leverage internal and external networking to drive optimal initiative results and knowledge/best practice transfer.Collaborate with Aetna Better Health, OhioRISE plan staff that support oversight of CME activities.

Required Qualifications

5+ years’ experience with one or more of the following methodologies: management consulting, project consulting, business process consulting, strategic business planning, relationship management, provider/network relations, quality improvement or salesAbility to communicate in a highly effective manner with internal and external stakeholders in both written and oral format.Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously.Demonstrated leadership with relevant initiatives: Business process, compliance, enterprise business project management/consulting, and analysis, strategic planning, risk management.Proficient in Microsoft Office Products (PowerPoint, Excel, Teams, Outlook, Word)Demonstrated experience successfully implementing change in complex organizations.Ability to travel within the Western Region of Ohio on a regular basis (geographical proximity preferred).Reside in the state of Ohio

Preferred Qualifications

Experience working in PowerBI, QuickBase, ASANA and EHRPrevious experience in managed care operationsPrevious experience working in behavioral health management

We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy.  Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week. Aetna Service Operations office/hub locations will be discussed with the selected candidate.

Education

Bachelor’s degree or equivalent work experience

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Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $119,340.00

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. 
 

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: 04/01/2025

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