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Manager, Clinical Health Services – Aetna Medicaid UM Letters Team
Job Description:
- Lead the day-to-day operations of a Medicaid Centralized Letters team
- Ensure accurate and timely delivery of member notification and authorization determination communications
- Ensure compliance with state contractual requirements, regulatory standards, accreditation requirements, and established turnaround times
- Monitor operational performance and analyze data to identify opportunities for process improvement, quality enhancement, and increased efficiency
- Partner with internal business partners, peer leaders, and external vendors to support effective execution of member communication processes
- Implement and monitor clinical policies, procedures, and operational practices in accordance with applicable state, federal, and accreditation requirements
- Support continuous improvement efforts by identifying and implementing best practices that improve service delivery and operational performance
- Manage a team of approximately 20 colleagues
- Develop high-performing teams and support strategic initiatives across the centralized letters organization
Requirements:
- Active, current, and unrestricted RN license in the state of residence
- 5 years relevant work experience
- 2+ years of managed care experience
- Demonstrated leadership experience in a Team Lead, Supervisor, or higher-level leadership role
- Proficiency with Microsoft Office applications, including Outlook, Word, Excel, and PowerPoint
- Ability to work core business hours, Monday through Friday, 8:00 AM to 5:00 PM, with flexibility to work occasional weekends as business needs require
- Ability to work beyond regularly scheduled hours as needed to meet business objectives
- Ability to travel up to 5% for meetings, audits, and implementation activities
- Experience with Utilization Management and prior authorization processes
- Experience working with state contractual requirements, regulatory guidelines, and member notification compliance within a managed care environment
- Experience with NCQA standards and accreditation requirements
- Experience partnering with external vendors to support operational objectives
- Ability to work independently in a remote environment while effectively collaborating with virtual teams
- Master’s degree or equivalent clinical experience
- If candidate has associate’s degree, additional 4 years of experience is needed
- If candidate has bachelor’s degree, an additional 2 years of experience is required
Benefits:
- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
