Manager, Care Management – RN

Job not on LinkedIn

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $78.3k - $168.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Develop, implement, support, and promote health services strategies, tactics, policies, and programs for Aetna Better Health of Oklahoma members • Oversee and manage clinical team processes, including organization and development of high-performing teams • Ensure care management and care coordination across the continuum of care: assessing, planning, implementing, coordinating, monitoring, and evaluating • Manage assigned care management teams and ensure adherence to established practices, policies, and procedures • Participate in recruitment and hiring of staff • Develop, initiate, monitor, and communicate performance expectations • Assess developmental needs and implement action plans supporting high-performing teams • Support management of complex physical and behavioral health cases • Facilitate appropriate healthcare outcomes and ensure access to primary care, behavioral health, and coordinated services • Provide clinical leadership and support care management staff • Conduct individual and team meetings focused on member service delivery, administrative duties, and productivity standards • Consult with care managers, medical directors, system of care, social support teams, and market staff to overcome barriers • Identify and escalate quality-of-care issues • Communicate strategic plans and tactics and ensure implementation for cost and quality outcomes • Identify best practices and innovations to improve outcomes • Meet clinical, operational, and quality objectives • Lead change efforts and maintain compliance with policies and procedures • Develop processes and resources for members who opt out of care coordination • Integrate care management, care coordination, and disease management into population health and quality improvement activities • Evaluate and interpret data, identify improvement areas, and focus interventions to improve outcomes

🎯 Requirements

• Active, unrestricted Registered Nurse (RN) license in state of residence; Oklahoma RN preferred • 5 years in clinical area of expertise • 3 years demonstrated leadership experience including supervision or management of direct reports • Minimum of 2 years’ care management experience; within managed care organization preferred • Knowledge of regulations, standards, and policies relating to medical management • Proficiency with personal computer, keyboard navigation, and MS Office Suite applications • Oklahoma resident preferred • Managed care experience with Medicaid, Medicare, or Commercial plans; Medicaid highly preferred • Certified Case Manager (CCM) preferred • Master’s degree equivalent experience • Associate’s degree plus 4 additional years of experience, or bachelor’s degree plus 2 additional years of experience, may satisfy the master’s degree equivalent requirement

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program