Executive Director, Childrens System of Care - OhioRISE

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 Aetna Better Health is Aetna's Medicaid managed care plan. Backed by over 30 years of experience managing the care of those with a broad array of health care needs, our Medicaid plans have demonstrated that getting the right help when you need it is essential to better health. That's why Aetna Medicaid plans include the guidance and support needed to connect our members with the right coverage, resources, and care. We are focused on enhancing quality and population health outcomes while integrating CVS assets to bring accessible healthcare to our members. The Aetna OhioRISE plan is recruiting for an Executive Director, Children's System of Care who is a key member of the Aetna OhioRISE leadership team, reporting to the CEO. This leader will work in close partnership with the CEO, COO, CMO, CFO, Care Coordination Director and all matrixed growth partners to effectively sustain and grow OhioRISE membership and ensure the operating efficiency and financial strength of the program. The successful candidate will have the drive, expertise, executive presence, and business acumen to maintain operational excellence. This Executive Director will ensure the organization understands Ohio's needs and delivers on all contract requirements, compliance benchmarks and timelines. Key Responsibilities Leads the design, implementation and oversight of the OhioRISE Behavioral Health care service delivery program. Develops and executes a comprehensive strategy aligned with the overall goals of OhioRISE and ensures that the needs of all enrolled children, youth and their families are adequately and appropriately met by maintaining oversight of the administration of all clinical aspects of the Health Plan. Provision of a cohesive OhioRISE program experience for all members, regardless of their care coordination Tier level (Tier 1, Tier 2, and Tier 3). Comprehensive oversight of the Care Management Entities (CMEs) which are responsible for Tiers 2 and 3 care coordination. Comprehensive oversight of Psychiatric Residential Treatment Facilities (PRTF) development and implementation. Development and implementation of the CME Alliance Hub and PRTF Hub that will direct the daily activities of the Aetna colleagues dedicated to supporting the CMEs and PRTF's. Establishment and growth of the OhioRISE program's recognition and presence at local, county, regional and state levels. Fostering collaborative relationships with the various child-and youth-serving agencies at both local and state levels. Orchestration and management of Aetna OhioRISE colleagues tasked with stakeholder outreach and engagement. Accountability for efficient, effective, and appropriate coordination and delivery of services to all enrollees and their families. Achievement of deliverables, outcomes and requirements of the OhioRISE program as determined by the Ohio Department of Medicaid (ODM). Understanding and education of OAC as it relates to Behavioral Health and OhioRISE. Crafting and implementation of practice adjustments and policy and procedure revisions. Establishing a positive organizational culture as experienced by Aetna colleagues, enrollees, providers, and external stakeholders. Actively shaping the Ohio behavioral health system of care and resolving issues and challenges identified. Developing and implementing strategies to increase the availability of the following services: Intensive Home-Based Treatment (IHBT), In-state Psychiatric Residential Treatment Facilities (PRTF), Behavioral Health Respite, Primary Flex Funds and Mobile Response and Stabilization Services (MRSS) and supports for family peer specialists. Implementing strategies for Early identification of care needs (e.g., behavioral health screening and assessment, identification of SDOH needs, connection to natural supports, and community-based services). Overseeing CME activities and their coordination of BH services across the full spectrum of care to members, inclusive of mental health and substance abuse services, and in collaboration with the community and local providers. Ensuring access to behavioral health services. Identifying and coordinating assistance for member needs specific to BH. Participating in management and program improvement activities with other key staff for enhanced integration with primary care and coordination of BH services and achievement of outcomes. Engaging in oversight and quality improvement activities associated with case management activities, providing guidance to BH network development recruitment, and value-based contracting, including CMEs in conjunction with OhioRISE Plan's provider relations, COE(s) and ODM. Assisting in the review of utilization data to identify variances in patterns and providing feedback and education to OhioRISE Plan's staff and providers as appropriate. Ensuring whole person care by fully integrating physical and behavioral health throughout the care continuum and actively managing transitions of care. Works in close partnership with the Care Coordination Director. Required Qualifications The candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company's business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes: 10+ years of relevant work experience. Specialty experience with children and adolescents with complex behavioral health needs, multi-system experience, and understanding of managed care. 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. Proven team leadership experience - leadership skills to build high-performing teams, manage and develop talent, influence, and impact a broad set of stakeholders, engage, and inspire others, and lead by example. Ability to work collaboratively across many teams, prioritize demands from those teams, synthesize information received, and generate meaningful conclusions. Excellent communication and relationship management skills and be able to express thoughts in an organized and articulate manner. Demonstrated success in leading cross-functional strategic initiatives in complex matrixed environments. Strong leadership, executive communication, and team development skills. Ability to work Hybrid Model (in office 3 days a week). Education Bachelor's degree required. Advanced degree preferred. Pay Range The typical pay range for this role is: $131,500.00 - $303,195.00 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. This position also includes an award target in the company's equity award program. 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 We anticipate the application window for this opening will close on: 08/31/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.