Director Care Management, CVS Health

CVS Health

Location:
United States, Work At Home, Florida

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

99420.00 - 214137.00 USD / Year

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Job Description:

The Director, Care Management, oversees the implementation and on-going execution of the strategic and operational business plan for clinical operations. The Director coordinates policies and procedures in support of financial, operational, and service requirements and implements care management/care coordination services provided to plan populations to meet Florida regulatory requirements and provide holistic bio-psychosocial care to members in a cost-effective manner

Job Responsibility:

Leads the clinical team that supports timely health risk screenings, comprehensive assessments, care plan development and member interventions in accordance with the Aetna Better Health Risk Stratification Level Framework and Florida contractual requirements
Develops and manages clinical operations focused on improving clinical and financial outcomes, member engagement, member satisfaction, and use of best practices and standards
Serves as liaison with regulatory and accrediting agencies and other health business units
Formulates and implements strategies for achieving applicable department/unit metrics and provides operational direction
Responsible for cross-functional integration of care coordination and case management, program operations with core organization-wide business functions including claims, member services, compliance, quality, utilization management, and network/provider services
Serves as technical, professional and business resource (may cross multiple business functions)
Supports quality improvement projects through successful implementation
Develops and participates in presentations and consultations to internal and external stakeholders
Directs/provides enhancements to business processes, policies and infrastructure to improve clinical operational efficiency (may cross multiple business functions)
Develops, implements, and evaluates 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 clinical 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
Ability to synthesize program performance and clinical outcomes
Promotes 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
Knowledge of the regulations, standards, and policies which relate to medical management
Ability to communicate in a highly effective manner with internal and external constituents in both written and oral format
Ability to evaluate and interpret data for the purposes of monitoring staff performance, regulatory compliance, and development of new programs and processes to meet business demands
Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams
Conducts all administrative duties in accordance with established standards for supporting and managing a team

Requirements:

Florida resident
Active unrestricted Florida licensure in one of the following clinical areas: RN or LCSW, LMFT, LPC, LMHC
5-7 years of clinical practice experience in physical or behavioral healthcare
3-5 years of management or clinical leadership in managed care
Managed care experience, specifically Medicaid
Care management experience
3+ years of experience with personal computer, keyboard navigation, and MS Office Suite applications

Nice to have:

Care management certification
Transition of care experience
Pediatric experience
Community Health Worker program experience
Ability to confidently interact at the executive level, within the c-suite

What we offer:

Affordable medical plan options
401(k) plan including matching company contributions
Employee stock purchase plan
No-cost programs including wellness screenings, tobacco cessation, and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
March 19, 2025

Expiration:
April 28, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Director Care Management