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Aetna is now a CVS Health Company

Licensed Care Management Manager - WV MCD

Primary Location: Charleston, WV
Additional Locations: WV-Charleston
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Description:
Oversight and Management of clinical team processes including the organization and development of high performing team.

Fundamental Components:
  • Reinforces clinical philosophy, programs, policies, and procedures.
  • Communicates strategic plan and specific tactics to meet plan.
  • Ensures implementation of tactics to meet strategic direction for cost and quality outcomes.
  • Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results.
  • Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
  • Accountable for meeting the financial, operational, and quality objectives of the unit.
  • May be accountable for the day-to-day management of teams for appropriate implementation and adherence with established practices, policies and procedures if there is not supervisor position
  • Works closely with functional area managers to ensure consistency in clinical interventions supporting our plan sponsors.
  • Develop, initiate, monitor, and communicate performance expectations.
  • May act as a single point of contact for the customer and the Account Team which includes participation in customer meetings implementation and oversight of customer cultural requirements, and support implementation of new customers.
  • Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical, and performance skills.
  • Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams.
  • 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.
  • Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.


Background Experience:
- Registered Nurse-BSN (MSN is preferred) OR a Master's degree in Behavioral Health field required.
- Active unrestricted WV State Licensure in applicable functional area (eg. RN, LCPC, LICSW) required.
- 5+ years experience in clinical area of expertise required.
- 2+ years supervisory experience required.
- 3+ years’ experience in Care Management and comprehensive understanding of CMS rules and regulations required.
- Experience working within a regulatory environment is required.
- Policy and procedure experience with a demonstrated ability to operationalize policies to desktops required.

Additional Job Information:
Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of West Virginia is 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 our members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of West Virginia, and we will support you all the way.


Required Skills:
Benefits Management - Maximizing Healthcare Quality, Benefits Management - Understanding Clinical Impacts, Leadership - Engaging and Developing People

Desired Skills:
Benefits Management - Interacting with Medical Professionals, Finance - Managing Aetnas Risk, Leadership - Collaborating for Results

Functional Skills:
Clinical / Medical - Direct patient care (hospital, private practice), General Management - Multi-functional management: < 25 employees, Medical Management - Medical Management - Case Management

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Education:
Mental Health - Licensed Clinical Social Worker, Mental Health - Licensed Professional Counselor, Nursing - Registered Nurse (RN)

Potential Telework Position:
Yes

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

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

Candidate Privacy Information:
Aetna takes our candidate'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.

Click To Review Our Benefits (PDF)

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