Director Case Management - Aetna Better Health of Oklahoma - RN

CVS Health • Milesburg, PA

2d • $99,420 - $214,137 • Remote

About The Position

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary 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.

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)

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

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees