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Position Summary
Aetna Better Health is Aetna’s Medicaid managed care plan. Backed by over 30 years of experience managing the care of those with a broad array of health care needs, our Medicaid plans have demonstrated that getting the right help when you need it is essential to better health. That’s why Aetna Medicaid plans include the guidance and support needed to connect our members with the right coverage, resources, and care. We are focused on enhancing quality and population health outcomes while integrating CVS assets to bring accessible healthcare to our members.
The LTSS Director, Clinical Health Services (Director), will partner closely with the LTSS Executive Director, Market CEO, DSNP Senior Leadership Clinical Health Services, Centers for Medicare and Medicaid Services, and State Agencies to build a transparent and trusting relationship while meeting federal and state objectives.
The Director will collaborate across the enterprise to ensure that the State LTSS program and Aetna objectives are aligned, business strategies are delivered and financial, compliance and quality objectives are met.
You will make an impact by:
- Leading, developing, and motivating a high performing team to meet organizational goals and objectives while effectively managing change. Ensuring that processes are aligned with the highest quality standards required by Accreditation and Credentialing Organizations (for example, NCQA).
- Overseeing and ensuring compliance with all applicable Federal and State regulations relevant to the plan’s function. Developing and maintaining tools and processes for proactive monitoring for all relevant quality and compliance performance metrics. Partnering effectively with Program Integrity operations to meet LTSS / DSNP requirements.
- Promoting 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.
- Implementing and monitoring the business plan and overseeing any implementations or business transitions impacting service operations. Developing and managing clinical operations focused on improving clinical and financial outcomes, member engagement, and satisfaction.
- Developing and implementing staffing models that are consistent, cost effective, and compliant with contractual obligations. Leading recruitment and operating model development to meet operational growth needs. Fostering an environment that supports professional development, mobility, and operational excellence.
- Developing, implementing, and promoting Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna Health Services strategies, policies, and programs.
- Overseeing the implementation and on-going execution of the strategic and operational business plan for the business segment's clinical operations, inbound/outbound call queue, implementation, and/or plan sponsor operations.
- Coordinating business segment policies and procedures in support of financial, operational and service requirements. Developing, implementing, and evaluating policies and procedures, which meet business needs (may cross multiple business functions). Directing enhancements to business processes, policies and infrastructure to improve operational efficiency (may cross multiple business functions). Collaborating and partnering 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.
- Developing and participating in presentations and consultations to existing and prospective customers. Participate in internal and external health industry development efforts.
Required Qualifications
- Pennsylvania resident
- Active, current and unrestricted Licensure in state of Pennsylvania (LCSW, LCPC, RN, LMFT)
- Ability to develop business cases for new staffing investments and work with finance to secure funding when additional staff are warranted.
- Ability to develop, evaluate and articulate current status, planning, and strategic initiatives via executive level presentations and able to speak professionally to Executive Level audience.
- Ability to successfully motivate, drive and lead colleagues in Manager, Supervisory and field level positions.
- Ability to interpret State contract to ensure Pennsylvania market is performing to contract expectations.
Tenure Qualifications
- 5+ years of Medicare DSNP, Medicaid LTSS leadership Required
- 10+ Years of Managed Care experience preferred
Education
- If RN - Associates or B.S. Degree in Nursing, Masters preferred
- If LCSW - Masters in Social Work
Pay Range
The typical pay range for this role is: $110,467.50 - $237,900.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
We anticipate the application window for this opening will close on: 11/29/2024.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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