Senior Manager Behavioral Health Clinical Strategy

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
CVS Health is the leading health solutions company, delivering care like no one else can. We reach more people and improve the health of communities across America through our local presence, digital channels and over 300,000 dedicated colleagues - including more than 40,000 physicians, pharmacists, nurses, and nurse practitioners. Wherever and whenever people need us, we help them with their health - whether that's managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system - and their personal health care - by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.

The Sr. Clinical Strategist serves as a Behavioral Health expert within the Office of the Chief Psychiatric Officer and reports to the Executive Director, Behavioral Health Innovation and Enterprise Connectivity. This position demands clinical experience across a broad spectrum of behavioral health disorders, clinical interventions, and program frameworks. It requires a working understanding of Utilization Management, Case Management, Quality Management, and Medical Management, alongside the ability to source and interpret evidence-based research, industry trends, and information regarding Behavioral Health vendors and providers.

The Sr. Clinical Strategist is responsible for assisting in the identification of innovative methods to deliver evidence-based care aimed at reducing disability and suffering, enhancing the health and productivity of members and customers with mental health conditions, and mitigating adverse economic impacts on these individuals, their families, and the healthcare system. Responsibilities include evaluating current BH clinical offerings and trends within the marketplace, managing pilot studies to assess emerging technologies, reviewing CVS Health / Aetna clinical BH programs, and assisting in the development of opportunities to integrate various CVS Health resources to ensure seamless BH experiences for our members and customers.

Additionally, the Sr. Clinical Strategist acts as the Behavioral Health Subject Matter Expert (SME) for key stakeholders within the enterprise concerning issues related to clinical programs and product development in Behavioral Health. The Sr. Clinical Strategist also serves as the Behavioral Health SME for departments such as Member Services, Provider Relations, Network, CVS Health policy, and provider Credentialing.

The candidate will collaborate across business units to ensure that the behavioral health strategy aligns with business growth and impact objectives. They are expected to oversee the timely and effective implementation of initiatives that align with enterprise and business goals, while proactively addressing ongoing needs.

This full-time, remote position can be based anywhere within the United States. Role Responsibilities :

• This position supports Team Leadership (Directors and Executive Directors) on the planning and execution necessary to drive BH Innovation tests and ensure compliance with appropriate BH standards of care and regulatory requirements. The role supports the organization's objectives by creating and recommending:
  • BH Products
  • Workflows
  • Policies

• Use extensive clinical experience to source and interpret evidence-based literature for clinical strategy and program development.

• Assists in the development of programs to counsel and train a team of professionals leveraging their clinical experience to ensure that team members receive appropriate training, maintaining consistency across applicable lines of business.

• Ensuring adherence to the business effects of the Mental Health Parity and Addiction Equity Act final rule released in September 2024.

• Ensure clinical processes comply with Federal and State regulations

• Assists in the development and implementation of BH clinical health protocols with partners, ensuring regulatory compliance and supporting organizational goals.

• Acts as a clinical liaison for partner teams and business leaders on behavioral health innovation or policy.

• Assists in the development of reporting analysis for senior leadership, vendors, and senior clinical health services strategist to ensure the highest standards of data quality and integrity.
• Participates in advocacy for change, influences others on program/project value, manages interpersonal sensitivities, and articulates strategic views for project alignment.

• Helps develop top clinical health services strategies aligned with organizational goals.

• Offers consultative advice to staff on program and project development and execution.

• Offers clinical expertise on CVS Health/Aetna's behavioral health programs to customers as needed.

• Assists in oversight of the utilization of external resources and vendors in a cost-effective manner to execute tasks essential for BH innovation programs and projects.

• Demonstrates behaviors as specified in Employee Competencies

• Bachelors or Masters Level Registered Nurse and/or Masters Level Behavioral Health certification (e.g. LPC, LMFT, LCSW, LMHC, LCMHC, LICSW, Clinical Psychologist)
• Active and Unencumbered license
• 7+ years of experience managing complex projects within a clinical or healthcare setting.
• 5+ years of total business experience
• 7+ years of clinical experience within health care industry/knowledge of CPT and HCPCS coding guidelines and principles
• Comprehensive clinical understanding of treatments and interventions, LOC, established and emerging clinical evidence of both acute and chronic presentation of the following behavioral health disorders: Substance Use Disorders for adolescents, young adults, adults and senior age cohorts and the impact on families and caregivers.
• Effective communicator with peers and senior leaders, both 1:1 and in small groups
• Strong management skills - can see both forest (strategy) and trees (detail oriented)
• Entrepreneurial, can move projects ahead and problem solve obstacles encountered without senior leader input; anticipates roadblocks prior to their occurring
• Proven experience successfully managing complex projects and cross functional teams.
• Ability to connect and tie initiatives and concepts across multiple business functions.
• Demonstrates strong ability to communicate technical concepts and implications to business partners and senior leaders
• Demonstrated ability to work effectively and collaboratively in a fast-paced, matrixed environment
• Knowledge of pertinent policies and procedures related to claims payment of healthcare related services.

• RN/Clinician experience using clinical expertise in reviewing claims medical records
• RN/Clinician experience in providing clinical guidance and input in the business analytic building process
• RN/Clinician experience BH innovation, test and learn pilot design and clinical measurement
• RN/Clinician experience clinical use case and business case development

• Bachelors or Masters Level Registered Nurse and/or Masters Level Behavioral Health certification (e.g. LPC, LMFT, LCSW, LMHC, LCMHC, LICSW, Clinical Psychologist)
• Active and current state license(s) without encumbrances
• 5+ years of post-graduate direct patient care experience

• 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.