Senior Manager Care Management - Aetna Better Health TX

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
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, you’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.