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.

　　Program Overview

　　Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Medicare and Medicaid Program (MMP) members, who are enrolled in Medicare and 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 as we grow and expand MMP to change lives in new markets across the country.

　　Position Summary

　　The Sr Manager - Clinical Health Services will oversee the implementation of healthcare management services for assigned functional area of Western and Southern OH including Toledo, Columbus and Cincinnati.

　　Fundamental Components

　　• Will lead a team of managers and individual contributors (approximately 80 in total) implementing change, driving efficiencies and promoting a culture that fosters accountability and joining forces

　　• Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g., NCQA, URAC, 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

　　• May act as a liaison with other key business areas, internally and externally

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

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

　　• Protects the confidentiality of member 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

　　• Lead by example, and shape 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

　　• Communicate effectively with Providers, Members, Staff and other Leaders (e.g., may provide support to the sales staff & network staff via onsite customer visits and/or presentations)

　　Requirements

　　Seven years of experience working with Medicare and/or Medicaid

　　Five years of people management experience

　　Managed Care experience (external candidates)

　　Registered Nurse with an active and unrestricted license in the state of OH

　　Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually

　　Project management experience and experience leading projects independently

　　Advanced execution and delivery (planning, delivering, and supporting) skills

　　Mastery knowledge of phases of care transitions and resources available for patients

　　Preferred

　　* Managed Care experience (internal candidates)

　　Education

　　Bachelor's degree preferred

　　Pay Range

　　The typical pay range for this role is:

　　$97,500.00 - $210,000.00

　　This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

　　In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

　　For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

　　CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

　　You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

　　CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.