Director Case Management - Aetna Better Health of Oklahoma - RN
About The Position
The Director of Care Management is a key member of the Aetna Better Health of Oklahoma leadership team. This role oversees the implementation and execution of the strategic and operational business plan for clinical operations. The Director ensures compliance with Oklahoma regulatory requirements while delivering holistic, cost-effective, bio-psychosocial care to members through care management and coordination services. The Director Case Management reports to the Senior Principal Clinical Leader. This is a fully remote role but may require onsite meetings. Eligible candidates must live within a one-hour commute to Oklahoma City. Relocation assistance may be available to eligible applicants.
Requirements
- Active and unrestricted Oklahoma Registered Nurse (RN) license
- Minimum 10 years of clinical practice experience
- At least 5 years of management or clinical leadership, including oversight of case management leaders
- 5 years of case management experience
- Managed care experience (Medicaid strongly preferred; commercial or Medicare experience acceptable)
- 3+ years of proficiency with personal computer use, keyboard navigation, and MS Office Suite
- Nationally recognized case management certification (required or must be obtained within 90 days of employment)
Nice To Haves
- BSN preferred
Responsibilities
- Lead the clinical team to ensure timely health risk screenings, comprehensive assessments, care plan development, and member interventions in alignment with Aetna Better Health Risk Stratification Framework and Oklahoma contractual requirements.
- Develop and manage clinical operations to improve clinical and financial outcomes, member engagement, satisfaction, and adherence to best practices and standards.
- Serve as liaison with regulatory and accrediting agencies and other health business units.
- Formulate and implement strategies to achieve departmental metrics and provide operational direction.
- Integrate care coordination and case management with core business functions, including claims, member services, compliance, quality, utilization management, and provider services.
- Support quality improvement initiatives and oversee successful implementation.
- Direct enhancements to business processes, policies, and infrastructure to improve clinical operational efficiency.
- Develop and evaluate policies and procedures to meet business needs.
- Implement and monitor business plans and oversee transitions impacting clinical operations.
- Collaborate with internal teams and corporate areas to ensure workflow processes and interdependencies are addressed.
- Analyze program performance and clinical outcomes to inform decision-making.
- Promote a clear vision aligned with company values; set challenging objectives and motivate teams to achieve results.
- Communicate effectively with internal and external stakeholders in both written and oral formats.
- Evaluate and interpret data to monitor staff performance, ensure regulatory compliance, and develop new programs and processes.
- Assess team development needs and implement action plans to build high-performing teams.
- Conduct administrative duties in accordance with established standards for team management.
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
- Relocation assistance may be available to eligible applicants.
- CVS Health bonus, commission or short-term incentive program
- award target in the company’s equity award program
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What This Job Offers
Job Type
Full-time
Career Level
Director
