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.

Position Summary

This position oversees the implementation and on-going execution of the strategic and operational business plan for the business segment's clinical operations, inbound/outbound call queue, implementation, and/or plan sponsor operations. Coordinates business segment policies and procedures in support of financial, operational, and service requirements. Implements care coordination services provided to plan populations in order to meet specific regulatory requirements and provide holistic bio-psychosocial care to members in a cost-effective manner. As a member of the Key Personnel team for Aetna Better Health of Texas, the candidate will need to travel to required meetings throughout the state.

• Leads a clinical team that supports timely Health Risk Screenings, Comprehensive Assessments, Care Plan development and Enrollee interventions in accordance with the State contracts
• Develop and manage clinical operations focused on improving clinical and financial outcomes, member engagement, member satisfaction, and use of best practices and standards.
• Serve as liaison with regulatory and accrediting agencies and other health business units.
• Formulate and implement strategies for achieving applicable department/unit metrics and provide operational direction.
• Responsible for cross-functional integration of care management, program operations with core organization-wide business functions including claims, member services, compliance, quality, utilization management, and network/provider services.
• Serve as technical, professional, and business resource (may cross multiple business functions).
• Support quality improvement projects through successful implementation.
• Develop and participate in presentations and consultations to existing and prospective stakeholders.
• Direct/provide enhancements to business processes, policies, and infrastructure to improve clinical operational efficiency (may cross multiple business functions).
• Develop, implement, and evaluate policies and procedures, which meet business needs (may cross multiple business functions).
• Implements and monitors business plan and oversees any implementations or business transitions impacting clinical operations.
• Collaborates and partners with other business areas across/within regions or segments and within other centralized corporate areas to ensure all workflow processes and interdependencies are identified and addressed on an on-going basis.
• Ability to synthesize program performance and clinical outcomes.
• Promote a clear vision aligned with company values and direction; sets specific challenging and achievable objectives and action plans; motivates others to balance customer needs and business success; challenges self and others to look to the future to create quality products, services, and solutions.
• Knowledge of the regulations, standards, and policies which relate to medical management. Ability to communicate in a highly effective manner with internal and external constituents in both written and oral format. Ability to evaluate and interpret data for the purposes of monitoring staff performance, regulatory compliance, and development of new programs and processes to meet business demands.

• Must reside in Texas.
• Texas-licensed registered nurse with current unencumbered license and experienced in the activities of Care Management.
• Nationally recognized case management certification, or ability to obtain within 90 days.
• 5+ years of clinical practice experience in physical or behavioral healthcare.
• 5+ years of management or clinical leadership.
• 3+ years of experience with personal computer, keyboard navigation, and MS Office Suite applications.
• Must possess reliable transportation and be willing and able to travel in-state up to 15% of the time. National travel intermittently. Mileage is reimbursed per our company expense reimbursement policy.

• Master's degree preferred.
• Medicaid, insurance, managed care, experience.