Clinical Health Services Manager

Job Description
Work at home with minimal travel expected throughout the year.

Applicants should reside within an hour to Linthicum, MD. Must reside in Maryland, DC, or Virginia.

Standard business hours Monday-Friday.

The dedication of talented and caring health care professionals drives the delivery of high-quality, cost-effective products and services. They make it possible for members to get the right health care treatment for their needs – and for Aetna to keep its competitive edge

The Manager of Clinical Health Services will oversee and manage a team of clinicians and non-clinicians serving Medicaid members in the state of Maryland.
Reinforce health services philosophy, programs, policies, and procedures.
Ensure the implementation of tactics to meet strategic direction for cost and quality outcomes.
Identify opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
Accountable for meeting the financial, operational, and quality objectives of the unit.
- Accountable for the day- to day management of teams for appropriate implementation and adherence with established practices, policies, and procedures.
Work closely with functional area managers to ensure consistency in interventions supporting our state health plans.
- May act as a single point of contact for the customer and the account team which includes participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.
- Assess developmental needs and collaborate with others to identify and implement action plans that support the development of high performing teams. Consistently demonstrate the ability to serve as a model change agent and lead change efforts.
- Accountable for maintaining compliance with policies and procedures and implement them at the employee level.
- Ability to evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes.
- Develop guidelines for utilization of services and case staffing.
-Provide prompt resolution regarding issues that may surface from agencies, providers, contracted facilities, members, and their families.
- Provide staff training and development.
- Determine policies and procedures that are needed to ensure staff activities meet regulatory requirements.
- Prepare documentation for NCQA and audits.
- Collaborate with licensed staff from other areas that assist with oversight of clinical staff and activities of licensed personnel.
- Develop guidelines for utilization of services and case staffing.
-Work collaboratively with internal and external teams to build knowledge an improve processes
-Group facilitation/presentation skills that inform and influence internal and external parties

Pay Range
The typical pay range for this role is:
Minimum: 84,500
Maximum: 182,000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
- 2+ years of experience in managed care
- 2+ years’ experience managing staff
- 3+ years of experience in a physical and/or behavioral healthcare setting

One of the following is required:
-Maryland or Compact state Registered Nurse (RN)
-Pharm D
-Independent behavioral health clinician for the state of Maryland (LCSW, LPC/LCPC, etc.)

Preferred Qualifications
-1+ years experience with Medicaid populations.
-1+ years Microsoft Office (Outlook, Word, Excel, Power Point)
-1+ years project management experience
-1+ years experience familiarity with data analysis
-Demonstrated experience in providing physical health
Case Management services to include assessments, care planning, interventions, monitoring, reporting
- Experience in managed care organizations
- Ability to manage multiple timelines and produce evidence of driving toward success with regular updates on progress in all areas of clinical project or program management
- Participate in strategic projects and process improvements based on lessons learned
- Profound understanding of clinical workflows and best practices
- Ability to effectively manage client expectations and inspire confidence
- Demonstrated experience in managing large and complex clinical initiatives and projects
- Proven communication skills both written and verbal; able to communicate effectively with all levels of the enterprise
- Work collaboratively with internal and external teams to build knowledge and improve processes; experience in successfully building, maintaining, and supporting effective relationships across cross-functional teams to achieve goals
- Group facilitation/presentation skills that inform and influence internal and external parties
- Reinforce health services philosophy, programs, policies, and procedures.
-Proven communication skills both written and verbal and able to communicate effectively with all levels of an organization from C-Suite executives to front-line staff
-Experience in successfully building, maintaining, and supporting effective relationship across cross-functional teams to achieve goals

Education
Associates Degree minimum

Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. 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.