Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. The Quality Provider Liaison builds positive relationships between Aetna OhioRISE and its high-volume providers to facilitate high quality care for members. The Liaison achieves this goal through analyzing and sharing provider performance metrics related to quality, clinical outcomes, coding, and utilization used to support OhioRISE programs. They will be a liaison between OhioRISE providers and will work with them throughout the plan with a cross-functional team of clinical, analytics, provider relations and medical personnel. **Essential Functions** + Build and maintain strong professional relationships internally and with leaders and staff of provider organizations, specifically with Psychiatric Residential Treatment Facilities (PRTFs) + Assess current practice patterns, assets and challenges utilizing NCQA, HEDIS, CAHPS, state, and regulatory standards + Conducts provider practice assessments and evaluates results of the initial assessment to determine needs and opportunities for collaboration + Use advanced communication, presentation, and facilitation skills to communicate the strategy needed to achieve the objectives for the provider group + The QPL will provide our internal outreach team with a list of members that need to be contacted for scheduling appointments to close HEIDS gaps in care + Establish a project plan with the practice that identifies goals and objectives for improvement + Track progress toward goals and objectives monthly and develop solutions and action plans for poor progress + Assess and recommend new initiatives to assist providers in reaching their quality goals, including but not limited to enhanced usage of IT tools and various provider education trainings + Assess current practice patterns, assets and challenges utilizing NCQA, state, and regulatory standards + Assess configuration and providers’ current use of IT tools that support population health and care management (EMR, billing and scheduling software, population health tools, etc.) and suggest potential enhancements to configuration, workflows and/or processes + QPLs will attend JOC meetings with internal staff (POD Team where applicable) and provider staff to address quality specific concerns + If part of the POD team will follow the process outlined to address any quality issues and will collaborate with provider relations on any issues that may arise outside of quality for prompt resolution **Specific Duties** + Explore opportunities for improved, bi-directional information exchange between providers and ABH + Lead and facilitate workgroups both internally and externally to manage programs and measure key performance metrics + Design, implement and execute internal and external training sessions on quality and coding topics + Develop and track progress of opportunities for member experience improvement to positively impact CAHPS scores + Coordinate with provider office to set up clinic days to close care gaps for our members, supplying a list of members to our internal outreach staff to get members scheduled and make reminder calls + Evaluate program for barriers and opportunities to make changes as appropriate + Clinic Day management + Community engagement activities to help improve member compliance + Improve the understanding and sensitivity to the unique needs of ABH’s population and caregivers + Multi-departmental collaboration for member and provider outreach activities + Performs other duties and projects as assigned **Required Qualifications** + 3+ years’ experience in practice management or an administrative leadership role in a healthcare setting + 3+ years’ experience in healthcare with a focus on HEDIS and Quality with experience facilitating and leading meetings with provider offices and proven track record of improving performance with your market + An ability to travel less than 10% across Ohio for in-person provider support. Valid driver’s license in good standing and access to a reliable vehicle required with insurance. **Preferred Qualifications** + Licensed Behavioral Health Clinician i.e. LISW, LPCC, LSW or Licensed Nurse i.e., LPN, RN, APRN + Experience working in a behavioral health, residential, or psychiatric setting + Proficient in Microsoft Office tools such as Excel, Teams, Outlook, PowerPoint, and Word + Articulate and professional communication skills, both verbally and written + Knowledge of HEDIS and Pay for Performance metrics, and common billing practices + Strong analytical skills regarding HEDIS metrics and quality reporting + Demonstrated understanding of Medicaid industry standards and NCQA requirements + Ability to manage relationships with an emphasis on internal and external mid-level relationships + Ability to work across all levels of the organization, including working with executive audiences, vendors, and government as a customer + Demonstrated ability to project manage and implement strategies to improve performance + Demonstrated experience in leading significant cross-functional work that includes business owners, executive leadership, and peers across the organization **Education** + Bachelor’s degree in the healthcare field, social work, or the behavioral health field required **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: 10/27/2024 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.