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Director, Care Coordination and Case Management

Primary Location: Downers Grove, IL
Additional Locations: IL-Downers Grove
Oversees the care coordination and case management functions for MMAI and Medicaid for the local health plan. Manages field based and office based local care coordination and case management teams. Coordinates business segment policies and procedures in support of financial, operational and service requirements.

Fundamental Components:
Develop and manage case management and care coordination teams focused on improving clinical and financial outcomes, member engagement and satisfaction and contractual compliance. Serve as liaison with regulatory and accrediting agencies and other health business units. Formulate and implement strategy for achieving applicable department/unit metrics and provide operational direction. Serve as technical, professional and business resource (may cross multiple business functions). Develop and participate in presentations and consultations to existing and prospective customers. Direct/provide enhancements to business processes, policies and infrastructure to improve operational efficiency (may cross multiple business functions). Participates in internal and external health industry development efforts. Develop, implement, and evaluate policies and procedures, which meet business needs (may cross multiple business functions). Implements and monitors business plan and oversees any implementations or business transitions impacting service operations. Collaborates and partners with other business areas across/within regions or segments and within other centralized corporate areas to ensure all workflow processes and interdependencies are identified and addressed on an on-going basis. Promote a clear vision aligned with company values and direction; sets specific challenging and achievable objectives and action plans; motivates others to balance customer needs and business success; challenges self and others to look to the future to create quality products, services, and solutions.

Background Experience:
Experience in government programs managed care, Illinois program; Preferred
Experience with programs serving dual eligible and medically frail populations; Preferred
Proven ability to work in complex matrixed organizations; Required
Ability to synthesize program performance and clinical outcomes; Required
5+ Years clinical leadership experience; Required
Registered Nurse (Masters preferred) or Active unrestricted State Behavioral Health Clinical Licensure in applicable functional area; Required (eg RN, LPC, LCSW) Master's degree in behavioral health field.

Required Skills:
General Business - Demonstrating Business and Industry Acumen, Leadership - Creating Accountability, Leadership - Engaging and Developing People

Desired Skills:
General Business - Maximizing Work Practices, Leadership - Collaborating for Results, Leadership - Driving a Culture of Compliance

Functional Skills:
Clinical / Medical - Management: > 25 employees, Leadership - Lead a major change effortùculture change, Medical Management - Medical Management - Case Management, Medical Management - Medical Management - Managed Care/Insurance Clinical Staff

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

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

Potential Telework Position:

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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