Clinical Health Services Manager

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.

Position Summary( must reside in the state of Kentucky)

• Oversight and Management of clinical team processes including the organization and development of high-performing teams.
• Reinforces clinical philosophy, programs, policies and procedures.
• Communicates strategic plan and specific tactics to meet plan.
• Ensures implementation of tactics to meet strategic direction for cost and quality outcomes.
• Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results.
• Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
• Accountable for meeting the financial, operational and quality objectives of the unit.
• May be accountable for the day-to-day management of teams for appropriate implementation and adherence with established practices, policies and procedures if there is not supervisor position
• Works closely with functional area managers to ensure consistency in clinical interventions supporting our plan sponsors.
• Develop, initiate, monitor and communicate performance expectations.
• May act as a single point of contact for the customer and the Account Team which includes participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.
• Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills.
• Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high-performing teams.
• Consistently demonstrates the ability to serve as a model change agent and lead change efforts.
• Accountable for maintaining compliance with policies and procedures and implements them at the employee level.
• Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.

Required Qualifications

• 2+ years’ utilization review experience required.

• 5+ years of clinical practice experience in physical or behavioral healthcare.
• 2+ year’s managed care experience is required

• 2+ years of experience with personal computer, keyboard navigation, and MS Office Suite applications.
• 2+ years of healthcare management experience required (preferably in a managed care setting)

•Ability to work core business hours, Monday-Friday, 8am-5pm, with flexibility to work occasional weekend hours is required.

Ability to provide on-call UM coverage for nights and weekends on a rotational schedule as required by the State regulatory agency.  

Preferred Qualifications

• 5+ years managed care is preferred

• Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
• Medicaid experience.
• If RN, BSN degree preferred.

Education

Master's Degree in behavioral health field; or Registered Nurse (BSN preferred).

Pay Range

The typical pay range for this role is:

$78,331.50 - $168,714.00

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 eligi