Manager, Care Management – Aetna Better Health of Oklahoma – RN

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

The Manager, Care Management develops, implements, supports, and promotes health services strategies, tactics, policies, and programs that drive delivery of quality healthcare to Aetna Better Health of Oklahoma members. The Manager is responsible for oversight and management of clinical team processes including the organization and development of high performing teams. The Manager is also responsible for ensuring the functioning of care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating).

The Manager, Care Management reports to the Director, Care Management.

This role is fully remote. Eligible candidates may live anywhere in the contiguous United States, but preference will be given to Oklahoma residents.

Key Responsibilities

• Accountable for the day-to-day management of assigned care management teams for appropriate implementation and adherence with established practices, policies, and procedures.
• Participates in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills.
• Develops, initiates, monitors, and communicates performance expectations.
• Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams.
• Supports the management of complex physical and behavioral health cases by being clinically and culturally competent with appropriate training and experience.
• Utilizes critical thinking and judgment to collaborate and inform the care management process to facilitate appropriate healthcare outcomes for members.
• Ensures access to primary care, behavioral health, and coordination of health care services for members as needed.
• Provides clinical leadership and assists care management staff in supporting members’ understanding of service recommendations based on member need.
• Conducts regularly scheduled individual and team meetings with a focus on member service delivery, completion of administrative duties, and meeting established productivity standards.
• Using a holistic approach, consults with care managers, medical directors, system of care, social support teams and/or other market staff to overcome barriers to meeting goals and objectives.
• Identifies and escalates quality of care issues through established channels.
• Conducts all administrative duties in accordance with established standards for supporting and managing a team.
• Communicates strategic plan and specific tactics to meet plan needs and ensures implementation of tactics to meet strategic direction for cost and quality outcomes.
• Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
• Ability to communicate in a highly effective manner with internal and external constituents in both written and oral format.
• Accountable for meeting the clinical operational and quality objectives of the unit.
• Consistently demonstrates the ability to serve as a model change agent and lead change efforts.
• Accountable for maintaining compliance with policies and procedures and implements them at the employee level.
• Develops and implements processes and resources for providing support to members who opt out of care coordination.
• Ensures care management/care coordination and disease management are part of population health and quality improvement activities.
• Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.

Required Qualifications

• Active, unrestricted Registered Nurse (RN) license in state of residence – Oklahoma RN preferred
• 5 years in clinical area of expertise
• 3 years demonstrated leadership experience including supervision or management of direct reports.
• Minimum of 2 years’ care management experience required; within managed care organization preferred
• Knowledge of the regulations, standards, and policies which relate to medical management.
• Proficiency with personal computer, keyboard navigation, and MS Office Suite applications

Preferred Qualifications

• Oklahoma resident
• Managed care experience – Medicaid (highly preferred), Medicare or Commercial plans
• Certified Case Manager (CCM) preferred.

Education

Master’s degree equivalent* experience

*Equivalent years of experience defined by CVS Policy: If candidate has associate’s degree, additional 4 years of experience is needed. If candidate has bachelor’s degree, an additional 2 years of experience is required.

Anticipated Weekly Hours

Time Type

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.

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Additional Information

Company: CVS Health

Location: Oklahoma

Salary: $78,331.00 - $168,714.00 per year

Job ID: R1023777

Specialties: Managed Care, Care Manager, Case Manager

Required Licenses: RN

Experience Level: 5-10 years