Clinical Health Services Manager

Job DescriptionFull time opportunity open to candidates with an active RN, LPC or LCSW license in Virginia.The Supervisor is responsible for oversight of Care Management staff for the Virginia Medicaid team including the organization and development of high performing teams. Works closely with functional area managers to ensure consistency in clinical interventions supporting our members. Accountable for meeting the financial, operational and quality objectives of the Virginia Medicaid team.Fundamental ComponentsOversees the implementation of Care Management services for the Virginia Medicaid team. Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g. NCQA, CMS, state and federal standards and mandates as applicable). Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking. Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care. May act as a liaison with other key business areas. May develop and/or review new training content. May collaborate/deliver inter and intra-departmental training sessions. Protects the confidentiality of member information and adheres to company policies regarding confidentiality. Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating and documenting of care. Develop, initiate, monitor and communicate performance expectations. Ensures the team's understanding and use of information system capability and functionality.May have responsibility for their own case load work. 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. Establish an environment and work style that promotes the concept of teamwork and strong performance. Consistently demonstrates the ability to serve as a role-model and lead change efforts. Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when needed. Accountable for maintaining compliance with policies and procedures and implements them at the employee level.Required Qualifications- Registered Nurse or LCSW with an active unrestricted license in state (VA) of residence- 3+ years in clinical area of expertise- 3+ years experience in managed care expertise- 3+ years of previous leadership expertise- Must possess or have the ability to obtain high speed internet access for work- Weekly travel to Richmond, VA office required- Up to 25% travel will be required in the Central region- Computer literacy and experience familiarity with Microsoft Excel, Word, and web-based applications desired.COVID RequirementsCOVID-19 Vaccination RequirementCVS 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.Preferred Qualifications- Ability to work with people in such a manner as to build high morale and group commitment to goals and objectives.- Ability to evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes.- Ability to communicate effectively with Providers, Members, Staff and other Leaders both in oral and written formats.- Ability to work on a fast-paced, growth oriented, high performing team- Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtuallyEducationIf RN BSN preferred, Associates degree required; If LCSW, LPC Master's degree in behavioral health field requiredBusiness OverviewBring your heart to CVS HealthEvery 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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.

Created: 2025-11-15