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Manager Clinical Health Services

Aetna Inc.

This is a Contract position in Boulder, CO posted May 15, 2022.

Job Description The Manager of Clinical Health Services position is 100% remote and candidates can apply from any state.

Normal Working Hours: Monday through Friday between 8:00am
– 5:00pm EST and may vary per the needs of the department.

There are occasional evening, weekend, and holiday on-call coverage to support the needs of the team.

No travel is required.

The Manager is responsible for oversight of the Commercial Engagement Hub.

This position is responsible for the development and monitoring of high performing teams.

Works closely with functional area leadership team (department Supervisors, CMAs, and other key stakeholders such as clinical leadership, program design/product, account teams/plan sponsor liaisons, etc.) to ensure consistency in supporting our members.

The Manager role includes (but is not limited to): Leadership of the Engagement Hub Supervisors and teams Accountable for meeting the financial, operational, and quality objectives of the unit Oversees the implementation of healthcare management services for assigned functional area Implements policies & procedures in accordance with applicable regulatory and accreditation standards (e.g., NCQA, URAC, 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/assist in development and/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 May collaborate with leadership for the development of, monitoring and communicating performance expectations Ensures the team’s understanding and use of information system capability and functionality 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, cross product integration, and continuum of care thinking that results in strong performance Consistently demonstrates the ability to serve as a model change agent 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 Must have an active and unrestricted RN license 3 years as a Registered Nurse 3 years of Managed Care experience 3 years of formal leadership in a supervisory role COVID Requirements COVID-19 Vaccination Requirement CVS 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 Certified Case Manager (CCM) Experience with ATV/ASD 1 years of Utilization Management experience BSN Experience utilizing pivot tables within MS Excel Ability to communicate effectively with Providers, Members, Staff, and other Leaders both in oral and written formats Ability to evaluate and interpret data, identifies areas of improvement Education Associates Degree in Nursing Business Overview Bring your heart to CVS Health Every 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.