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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.

The Manager Clinical Health Services is a key member of the Aetna Better Health of Virginia leadership team and is responsible for oversight and management of clinical team processes including the organization and development of high performing teams who are responsible for service delivery reviews. Manager reports to the Sr Principal Clinical Leader.

 

This is a remote position.  Eligible candidates must live in Virginia

 

Position Responsibilities

• 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 contract.
• 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 in and opt out of care coordination.
• Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.

 

Required Qualifications

• Virginia residence
• Active and unencumbered Virginia RN license
• 5+ years in clinical area of expertise
• 2+ years supervisory/managerial experience
• 3+ years care management experience
• 3+ years of experience with personal computer, keyboard navigation, and MS Office Suite applications
• Experience with DMAS Medicaid Enterprise System (MES)
• Must be willing to travel for state required meetings and trainings (up to 20% travel estimated)

Preferred Qualifications

• Medicaid experience – LTSS experience highly preferred
• Knowledge of the regulations, standards, and policies which relate to medical management
• Certified Case Manager (CCM)

Education

Registered Nurse (BSN preferred)

Pay Range

The typical pay range for this role is:

$87,035.00 - $187,460.00

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. 
 
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: 12/03/2024

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