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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
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