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Job 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 Director, Care Management, oversees the implementation and on-going execution of the strategic and operational business plan for clinical operations. The Director coordinates policies and procedures in support of financial, operational and service requirements and implements care management/care coordination services provided to plan populations to meet Florida regulatory requirements and provide holistic bio-psychosocial care to members in a cost-effective manner. 

The Director reports to the Regional Senior Principal Clinical Leader.  Eligible candidates must live in Florida.

Position Responsibilities

Leads the clinical team that supports timely health risk screenings, comprehensive assessments, care plan development and member interventions in accordance with the Aetna Better Health Risk Stratification Level Framework and Florida contractual requirements.Develops and manages clinical operations focused on improving clinical and financial outcomes, member engagement, member satisfaction, and use of best practices and standards.Serves as liaison with regulatory and accrediting agencies and other health business units.Formulates and implements strategies for achieving applicable department/unit metrics and provides operational direction.Responsible for cross-functional integration of care coordination and case management, program operations with core organization-wide business functions including claims, member services, compliance, quality, utilization management, and network/provider services.Serves as technical, professional and business resource (may cross multiple business functions).Supports quality improvement projects through successful implementation.Develops and participates in presentations and consultations to internal and external stakeholders.Directs/provides enhancements to business processes, policies and infrastructure to improve clinical operational efficiency (may cross multiple business functions).Develops, implements, and evaluates policies and procedures, which meet business needs (may cross multiple business functions).Implements and monitors business plan and oversees any implementations or business transitions impacting clinical operations.Collaborates and partners with other business areas across/within regions or segments and within other centralized corporate areas to ensure all workflow processes and interdependencies are identified and addressed on an on-going basis.Ability to synthesize program performance and clinical outcomes.Promotes a clear vision aligned with company values and direction; sets specific challenging and achievable objectives and action plans; motivates others to balance customer needs and business success; challenges self and others to look to the future to create quality products, services, and solutions.Knowledge of the regulations, standards, and policies which relate to medical management.Ability to communicate in a highly effective manner with internal and external constituents in both written and oral format.Ability to evaluate and interpret data for the purposes of monitoring staff performance, regulatory compliance, and development of new programs and processes to meet business demands.Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams.Conducts all administrative duties in accordance with established standards for supporting and managing a team.

Required Qualifications

Florida residentActive unrestricted Florida licensure in one of the following clinical areas: RN or LCSW, LMFT, LPC, LMHC5-7 years of clinical practice experience in physical or behavioral healthcare3-5 years of management or clinical leadership in managed careManaged care experience, specifically MedicaidCare management experience3+ years of experience with personal computer, keyboard navigation, and MS Office Suite applications

Preferred qualifications

Care management certificationTransition of care experiencePediatric experienceCommunity Health Worker program experienceAbility to confidently interact at the executive level, within the c-suite

Education

Registered Nurse (master’s preferred); or master’s degree in behavioral health field

Pay Range

The typical pay range for this role is:

$99,420.00 - $214,137.00

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. 
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 02/28/2025

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