Manager, Clinical Health Services – Aetna Medicaid UM Letters Team

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $78.3k - $168.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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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

• 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