Manager, Case Management - Aetna Better Health of Florida - Registered Nurse

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.The Manager, Care Management, develops, implements, supports, and promotes health services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to Aetna Better Health of Florida members. The Manager is responsible for oversight and management of clinical team processes including the organization and development of high performing teams. The manager is also responsible for ensuring the functioning of care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating).The Manager reports to the Director, Clinical Health Services, Care Management.This is a fully remote position. Eligible candidates must live in Florida.Position Responsibilities

• Accountable for the day-to-day management of assigned care management teams for appropriate implementation and adherence with established practices, policies, and procedures.
• Participates in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills.
• Develops, initiates, monitors, and communicates performance expectations.
• Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams.
• Supports the management of complex physical and behavioral health cases by being clinically and culturally competent with appropriate training and experience.
• Utilizes critical thinking and judgment to collaborate and inform the care management process to facilitate appropriate healthcare outcomes for members.
• Ensures access to primary care, behavioral health, and coordination of health care services for members as needed.
• Provides clinical leadership and assists care management staff in supporting members' understanding of service recommendations based on member need.
• Conducts regularly scheduled individual and team meetings with a focus on member service delivery, completion of administrative duties, and meeting established productivity standards.
• Using a holistic approach consults with care managers, medical directors, system of care, social support teams and/or other market staff to overcome barriers to meeting goals and objectives.
• Identifies and escalates quality of care issues through established channels.
• Conducts all administrative duties in accordance with established standards for supporting and managing a team.
• Communicates strategic plan and specific tactics to meet plan needs and ensures implementation of tactics to meet strategic direction for cost and quality outcomes.
• Serves as the Care Management subject matter expert with the Aetna Better Health of Florida Medicaid contract and contract deliverables.
• Ensures Care Management compliance with contract requirements.
• Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
• Ability to communicate in a highly effective manner with internal and external constituents in both written and oral format.
• Accountable for meeting the clinical operational and quality objectives of the contract.
• Consistently demonstrates the ability to serve as a model change agent and lead change efforts.
• Accountable for maintaining compliance with policies and procedures and implements them at the employee level.
• Develops and implements processes and resources for providing support to members who opt in and opt out of care coordination.
• Ensures care management/care coordination and disease management are part of population health and quality improvement activities.
• Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.

• Florida resident
• Active and unrestricted Florida RN license
• 5 years in clinical area of expertise, preferably pediatrics
• Care management experience within a managed care organization
• Knowledge of the regulations, standards, and policies which relate to medical management
• 3+ years of experience with personal computer, keyboard navigation, and MS Office Suite applications

• 3 years supervisory/managerial experience preferred
• Certified Case Manager (CCM) preferred

• 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.