Manager, Care Management - Aetna Better Health of Oklahoma - RN

CVS Health•Work At Home-Oklahoma, OK

9d•$78,331 - $168,714•Remote

About The Position

The Manager, Care Management develops, implements, supports, and promotes health services strategies, tactics, policies, and programs that drive delivery of quality healthcare to Aetna Better Health of Oklahoma members. The Manager is responsible for oversight and management of clinical team processes including the organization and development of high performing teams. The Manager is 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).

Requirements

Active, unrestricted Registered Nurse (RN) license in state of residence – Oklahoma RN preferred
5 years in clinical area of expertise
3 years demonstrated leadership experience including supervision or management of direct reports.
Minimum of 2 years’ care management experience required; within managed care organization preferred
Knowledge of the regulations, standards, and policies which relate to medical management.
Proficiency with personal computer, keyboard navigation, and MS Office Suite applications

Nice To Haves

Oklahoma resident
Managed care experience – Medicaid (highly preferred), Medicare or Commercial plans
Certified Case Manager (CCM) preferred.

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 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.