Clinical Transformation Specialist

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
Aetna Better Health of Oklahoma, a CVS Health company, is a trusted health partner in the local Oklahoma communities we serve. We provide a full array of innovative services that enhance overall wellness and improve everyday life for our members.  At Aetna Better Health of Oklahoma, we value professional development and career growth.  You will work along other colleagues who align on Heart at Work behaviors and bringing your heart to every moment of health.  We will support you all the way!

This is a fulltime teleworker opportunity in Oklahoma. Qualified candidates preferably will reside within the greater Oklahoma City area which includes the following counties: Oklahoma, Kingfisher, Logan, Payne, Lincoln, Pottawatomie, Cleveland, Grady, and Canadian, This role will require in-state travel up to 25% of the time.

Working schedule is Monday-Friday, 8am-5pm (CST) with flexibility to work outside of business hours, as needed.

This position will support the improving coordination, support, engagement, and management for Aetna Better Health of Oklahoma Medicaid members through building relationships with providers focused on care that integrates physical and behavioral health best practices.

• Coordination duties related to complex patient populations and collaboration of services with community programs and providers including both mental health, substance use and medical services.
• Identification of service gaps and development of solutions
• Collaborates with community providers and care management providers, including State and local community providers, providing information and technical support on implementing best practices for Integrative care encompassing both physical and behavioral health
• Interact with clinical and senior leaders within the health plan to discuss provider and practice needs around integration
• Monitor the administration of state specific programs to ensure compliance with required processes, identify staff training needs, and to collect program outcome data.
• Supports design, implementation, and monitoring of novel Value Based Arrangements and Alternative Payment Models with community providers around integrative care.
• Coordinate with health plan staff (e.g. Provider Relations, Network, Community Development, Behavioral Health) to support increased integrative care for our Oklahoma Medicaid members
• In conjunction with health plan staff (e.g. Utilization Management, Care Management) coordinate processes related to behavioral and physical health services, involving primary care physicians and related care team participants.
• Collaborate with Provider Services in monitoring the network to ensure compliance with state/contractual requirements and to identify areas of opportunity for integrative care delivery.
• May participate in training new and existing health plan staff on new programs, member health and service needs, and provider-related processes.
• Facilitate effective interactions with network and community service providers through provider education on behavioral and physical health, social service needs, and utilization
• Participate in local, regional, and state meetings with providers, community stakeholders, and state entities to increase integrative care for our Medicaid member

Required Qualifications

• Must reside in Oklahoma.  
• Oklahoma-licensed mental health professional- Licensed Professional Counselor (LPC), Licensed Marriage & Family Therapist (LMFT), Licensed Behavioral Practitioner (LFP), or Licensed Clinical Social Worker (LCSW) with current unencumbered license
• 8 years of experience working in a behavioral health field.  
• 5 years of demonstrated experience designing, implementing, and monitoring Physical Health-Behavioral Health Integration programs and initiatives.
• 5 years of experience collaborating and managing relationships with Oklahoma Behavioral Health providers
• 2 years of experience with Value Based, Pay for Performance, and/or Alternative Payment Models focused on integrative care
• 2 years demonstrated proficiency with personal computer, keyboard navigation, and MS Office Suite applications (Teams, Outlook, Word, Excel, SharePoint, etc.)
• Must possess reliable transportation and be willing and able to travel in-state up to 25% of the time. Mileage is reimbursed per our company expense reimbursement policy.

Preferred Qualifications

• Understanding, expertise, and work experience within the Oklahoma behavioral health services delivery system. 
• Experience in managed care related to behavioral health, provider relations, and/or network management. 
• Demonstrated experience working and collaborating with public and private services providers and building partnerships focused on PH-BH service delivery.

Education

• Master’s degree in Counseling, Social work, or closely related field. 

Pay Range

The typical pay range for this role is:

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 jobs.CVSHealth.com/benefits

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. 

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution. 

Salary : $76,050 - $163,800