Clinical Health Services, Associate Manager

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Fully remote.Program Overview

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Behavioral Health members, who are enrolled in Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs.Join us in this exciting opportunity.Position Summary

The Associate Manager, Clinical Health Service will oversee the implementation of healthcare management services related to behavioral health auditing and non-behavioral health auditing for assigned functional area.Fundamental Components

• Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g., NCQA, state and federal standards and mandates as applicable)

• Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking

• Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care through careful monitoring of provider documentation and application of clinical guidelines.

• May act as a liaison with other key business areas.

• May develop/assist in development and/review new training content

• May collaborate/deliver inter and intra-departmental training sessions

• Protects the confidentiality of member and provider information and adheres to company policies regarding confidentiality

• Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating, and documenting of care

• Evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes

• Develop, initiate, evaluate, monitor, and communicate performance expectations

• Ensures the team's understanding and use of information system capability and functionality

• Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills

• Assesses developmental needs and collaborates with others to identify and

implement action plans that support the development of high performing

teams

• Establish an environment and work style that promotes the concept

of teamwork, cross product integration, and continuum of care thinking that

results in strong performance

• Consistently demonstrates the ability to serve as a model change agent and lead change efforts

• Create a positive work environment by acknowledging team contributions, soliciting input,

and offering personal assistance, when needed Accountable for maintaining compliance with policies and procedures and implements them at the employee level

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.