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Qualified candidate must live in the state of Ohio

Position Summary

The OhioRISE Waiver Administrator will oversee and manage Waiver policies and procedures in support of financial, operational, and clinical service requirements, including serving as the primary point of contact with ODM. The Waiver Administrator works closely with the OhioRISE Care Management Entities (CMEs) by providing robust Waiver technical assistance to CME leadership and staff. The Waiver Administrator partners with the CME Alliance Hub and Aetna CM leadership to ensure oversight of Waiver compliance. The Waiver Administrator provides technical assistance to the Care Plan Review team to ensure reliable reviews that are in adherence to Waiver rules and criteria in the Ohio Administrative Code.

In addition, The Waiver Administrator ensures timely oversight and documentation of the OhioRISE Waiver reporting, both compliance and ad hoc, meeting all reporting and timeframe requirement.

a. Work with OhioRISE Plan’s senior leadership team, the Ohio Department of Medicaid (ODM), Care Management Entities (CMEs), Aetna Care Coordination, service vendors and other child-serving systems to support the design, implementation, and evaluation of OhioRISE Waiver processes that supports families, children, and youth being served through the OhioRISE plan.

b. In partnership with ODM and Aetna leadership, establish and maintain the Waiver process guidelines, including being the SME for Desktops, Job Aids, CME Manual, Member Handbook, Waiver Member Handbook and CM Program Description Manual.

c. Serve as the dedicated Administrative Waiver point of contact for ODM, CMEs, Aetna Care Coordination, FMS, vendors, and county/local child serving systems.

d. Oversee the process of Waiver LOC redetermination.

e. Provide Waiver technical assistance to OhioRISE Care Coordinators, including CMEs.

f. Coordinate, develop and lead Waiver education and training

g. Monitor compliance

h. Lead SME for Waiver policies and practices

i. Partnering with internal departments to resolve issues

j. Ensure Waiver workflows are created and updated

k. Support quality improvement objectives to perform data collection, analysis of trends, and opportunities for performance improvement.

l. Develop and complete regular and ad hoc Waiver reporting.

Required Qualifications

• At least two years’ experience in a setting that includes services or management of multi-system youth, work with local/community systems of care, and knowledge of Ohio’s child-serving systems.

• Knowledgeable of key resources for children, youth, and families in the State of Ohio.

• Demonstrated knowledge and understanding of Ohio’s overall behavioral health system that includes mental health, alcohol and drug addiction, developmental disabilities services, child welfare system, juvenile justice system, as well as Family and Children First Councils.

• Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of organizations simultaneously.

• Demonstrated experience successfully implementing change in complex organizations.

• Experience with large-scale initiatives with high degree of complexity.

• Exceptional verbal, written and presentation communication skills.

• Proven facilitation and project management skills, including meeting project milestones and negotiating for resources.

• Proven ability to satisfy customers’ needs and develop alternatives to resolve issues.

• Team leadership and team building skills.

• Critical thinking skills.

• Knowledge and experience with high fidelity wraparound and care coordination preferred.

• Ability to travel, mostly in-state with personal vehicle. Qualified candidates must have reliable transportation, valid/active driver’s license, and proof of vehicle insurance.

• Demonstrated proficiency with personal computer, keyboard navigation skill, and MS Office Suite applications.

• Must reside in Ohio

Education

• Bachelor’s degree required; Master’s Degree preferred.

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: 04/03/2025

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.