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A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Sr Director, DSNP Clinical Strategic Planning (57430BR)

Primary Location: Blue Bell, Pennsylvania
Additional Locations: NY-Albany, PA-Blue Bell
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Opportunity is open across the US and not location specific and we are willing to consider applicants based on location and full time work from home.

Position Summary:

The National DSNP Program Office supports DSNP growth, expansion, strategy, clinical & administrative operations for all DSNPs. This position is focused on strategic alignment of clinical initiatives; identifying opportunities to enhance capabilities to manage clinically and socially complex dually eligible populations. Position will be responsible for working with enterprise and segment clinical and related operational areas supporting DSNPs, serving as liaison focused on monitoring effectiveness and impact of clinical programs and facilitating development and implementation of program enhancements and new initiatives.

To be successful in this position, the candidate must have demonstrated experience with designing and implementing clinical and related operational programs for dual eligible and clinically complex Medicare populations and for understanding Medicare utilization management, Special Needs Plan model of care and care management requirements, and other specialized clinical initiatives. Lead strategic integration and ongoing enhancement of clinical programs and initiatives and utilization management for DSNP members including social determinants of health. Serve as liaison + clinical leader supporting the advancement of clinical programs and services to support DSNP performance and enhancing overall capabilities to manage complex populations. Work with clinical and related operational areas to identify improvement opportunities

Fundamental Components:
- Serve as liaison and clinical leader supporting the advancement of clinical programs and services to support DSNP performance and enhancing overall capabilities to manage complex populations
- Work with clinical and related operational areas to identify improvement opportunities
- Ability to synthesize program performance and clinical outcomes
- Demonstrated experience successfully implementing change in complex organizations
- Demonstrated superior business process, project management and organizational redesign experience
- Registered Nurse (Masters preferred)

BACKGROUND/EXPERIENCE desired:

(*) 10+ years clinical leadership Medicare and DSNP experience include care management and utilization management (*) Experience designing and implementing clinical and related operational programs for dual eligible and clinically complex Medicare populations and for understanding Medicare utilization management, Special Needs Plan model of care and care management requirements, and other specialized clinical initiatives
(*) Experience with Medicaid clinical programs and services including managed long term care services and supports preferred
(*) To be successful in this position, the candidate must have demonstrated experience with designing and implementing clinical and related operational programs for dual eligible and clinically complex Medicare populations and for understanding Medicare utilization management, Special Needs Plan model of care and care management requirements, and other specialized clinical initiatives.
(*) Lead strategic integration and ongoing enhancement of clinical programs and initiatives and utilization management for DSNP members including social determinants of health. Ability to synthesize program performance and clinical outcomes Demonstrated experience successfully implementing change in complex organizations Demonstrated superior business process, project management and organizational redesign experience
(*) Registered Nurse (Masters preferred)

EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is desired


FUNCTIONAL EXPERIENCES
Functional - Medical Management/Medical Management - Administration/Management/4-6 Years
Functional - Leadership/Lead a complex or multifunctional organization/7-10 Years
Functional - Nursing/Case Management/7-10 Years
Functional - Management/Management - Medicare/7-10 Years
Functional - General Management/Process & quality improvement/7-10 Years


Telework Specifications:
Full-Time Telework (WAH)

ADDITIONAL JOB INFORMATION
Opportunity to be part of new national office and work across the enterprise, markets and business units. New position as clinical strategy and innovation lead that spans quality, utilization management, clinical programs and services, member experience, network and care management

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.





Benefit eligibility may vary by position. Click here to review the benefits associated with this position.



Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

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