Manager, Behavioral Health Care Management - Aetna Better Health of OK - BH or RN

CVS Health • Milesburg, PA

2d • $78,331 - $168,714 • Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Summary: The 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 Oklahoma behavioral health (BH) membership. The Manager is responsible for oversight and management of clinical team processes including 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). The Manager reports to the Director, Clinical Health Services, Care Coordination. This is a fully remote, work from home position that may require on-site meetings. Eligible candidates must live in Oklahoma preferably within a one-hour commute to Oklahoma City.

Requirements

• Oklahoma resident
• Active, unrestricted clinical licensure (RN or Behavioral Health as outlined below).
• 5+ years of clinical practice which includes a strong behavioral healthcare focus
• 3 years’ experience managing direct reports
• 2 years’ experience in a managed care organization supporting Medicaid, Medicare, or Commercial plan members
• Case management experience
• Strong BH background with a focus on decreasing BH inpatient admissions and BH ED Utilization
• Knowledge of the regulations, standards, and policies which relate to medical management
• Successful completion of the Behavioral Health Case Manager certification training provided through the Department of Mental Health and Substance Abuse Services within 6 month of hire date
• 3+ years of experience with personal computer, keyboard navigation, and MS Office Suite applications
• Ability to maintain a work schedule aligned to Central Time Zone business hours, including two shifts per week ending at 9:00 p.m
• If Registered Nurse: Master’s degree or equivalent experience required (BSN preferred). Active, unrestricted Oklahoma nursing license Behavioral Health experience
• If Behavioral Health: Master’s degree in a field leading to independent Behavioral Health licensure Current unencumbered behavioral health clinical license (e.g. LPC, LMFT, LBP, LCSW, LADC)

Responsibilities

• Accountable for the day-to-day management of assigned care management teams for appropriate implementation and adherence with established practices, policies and procedures.
• 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 in order 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 unit.
• 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 out of care coordination.
• 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.

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: Manager