Responsible for the oversight of healthcare management staff including theorganization and development of high performing teams. Works closely withfunctional area managers to ensure consistency in health related andpsycho-social interventions supporting our members and is accountable formeeting the financial, operational and quality objectives of the unit.
Oversee the implementation of healthcare management services forassigned functional area. Accountable for maintaining policies & proceduresin accordance with applicable regulatory and accreditation standards andimplementing them at the employee level (e.g. NCQA, URAC, state andfederal standards and mandates as applicable). Ensure implementation andmonitoring of best practice approaches and innovations to better addressthe member's needs across the continuum of care. May act as a liaison withother key business areas. Manage resources responsible for identificationof members, development and implementation of care plans, enhancementof medical appropriateness and quality of care and monitoring, evaluatingand documenting of care. May have responsibility for their own case loadwork. May act as a single point of contact for the customer and the AccountTeam including: participation in customer meetings, implementation andoversight of customer cultural requirements, and support implementation ofnew customers. Assess developmental needs and collaborates with othersto identify and implement action plans that support the development ofhigh performing teams. Establish an environment and work style thatpromotes the concept of teamwork, cross product integration, andcontinuum of care thinking that results in strong performance. Consistentlydemonstrate the ability to serve as a model change agent and lead changeefforts. Collaborate with licensed staff from other areas that assist withoversight of clinical staff and activities of licensed personnel. Serve as acontent model expert and mentor to the team regarding practice standards,quality of interventions, problem resolution and critical thinking.
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
- If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
- If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.
3-5 years of experience in a physical or behavioral healthcare setting1-3 years management experience3-5 years of experience in managed careKnowledge of the regulations, standards, and policies which relate tomedical management
Certified Case Manager (CCM) preferred.Bachelor's degree in health or human services (e.g. Social Work,Psychology, Nursing, Mental Health, Counseling, Behavioral Sciences,Sociology, Gerontology or related field required.Master's degree in one of the above noted fields preferred.
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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