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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.
At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, youÂ’ll join a team dedicated to improving the lives of Texas members. We value diversity and are dedicated to helping you achieve your career goals.
The Senior Manager, Care Management develops, implements, supports, and promotes health services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to Aetna Better Health of Texas members. The Sr. Manager is responsible for oversight and management of Aetna Better Health Texas Manager(s) which includes the organization and development of high performing teams. 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).
This position reports to the Director, Clinical Health Services, Care Coordination.
This is a remote position, candidate must reside in TX
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 Texas contractual requirements.
• Serves as liaison with regulatory and accrediting agencies and other health business units.
• Serves as technical, professional and business resource (may cross multiple business functions).
• Supports quality improvement projects through successful implementation.
• Develops, implements, and evaluates policies and procedures, which meet business needs (may cross multiple business functions).
• Ability to synthesize program performance and clinical outcomes.
• 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.
• 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.
• Conducts regularly scheduled individual and team meetings with a focus on member service delivery, completion of administrative duties, and meeting established productivity standards.
• Conducts all administrative duties in accordance with established standards for supporting and managing a team.
• Serves as the Care Management subject matter expert with the Aetna Better Health of Texas Medicaid contract and contract deliverables.
• Ensures Care Management compliance with contract requirements.
• 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.
• 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.
• Accountable for internal and external metrics including member engagement goals and state requirements per contract.
• Accountable for supporting state audits, NCQA performance and audits and Clinical Strategy for RFPs.
• 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 Texas contractual requirements.
• Serves as liaison with regulatory and accrediting agencies and other health business units.
• Serves as technical, professional and business resource (may cross multiple business functions).
• Supports quality improvement projects through successful implementation.
• 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.
• 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.
• Conducts regularly scheduled individual and team meetings with a focus on member service delivery, completion of administrative duties, and meeting established productivity standards.
• Conducts all administrative duties in accordance with established standards for supporting and managing a team.
• Serves as the Care Management subject matter expert with the Aetna Better Health of Texas Medicaid contract and contract deliverables.
• Ensures Care Management compliance with contract requirements.
• 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.
• 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.
• Accountable for internal and external metrics including member engagement goals and state requirements per contract.
• Accountable for supporting state audits, NCQA performance and audits and Clinical Strategy for RFPs.
• Develops, implements, and evaluates policies and procedures, which meet business needs (may cross multiple business functions).
• Ability to synthesize program performance and clinical outcomes.
• 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.
Required Qualifications
• Active unrestricted Texas State License in applicable functional area. (e.g. RN,LPC, LCSW)
• 7 years in clinical area of expertise
• 7 years supervisory/managerial experience
• Care management experience
• Knowledge of the regulations, standards, and policies which relate to medical management.
• Care management experieence
• 3+ years of experience with personal computer, keyboard navigation, and MS Office Suite applications
Preferred Qualifications:
• Managed care experience
• Certified Case Manager (CCM)
• Texas Medicaid experience – specifically TX STAR and CHIP
Education
• Bachelor’s’ degree required for RN license or master’s degree in social services/clinical counseling for BH License.
Pay Range
The typical pay range for this role is:
$100,425.00 – $216,300.00
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 jobs.CVSHealth.com/benefits
We anticipate the application window for this opening will close on: 07/17/2024
