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.100% remote, full-time position. Candidates can live anywhere in the U.S. to be considered. Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care delivery system is more transparent and consumer-focused, and it recognizes licensed behavioral health clinicians for their ability to assess clinical quality and identify effective use of health care resources.
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The Manager, Clinical Health Services is an important clinical position that will leverage their clinical licensure and expertise in overall delivery of health care, medication management and discharge planning to obtain a holistic view of the health services being delivered to Aetna members. This clinician is responsible for leading the chart audit process and collaborating with internal stakeholders and external providers to make recommendations that will increase member safety and risk.Specific responsibilities include:
- Capitalizes on clinical expertise and knowledge to conduct clinical quality assurance audits of provider charts and review of key policies and procedures to assuring consistent use of audit tools and internal policies.
- Applies critical thinking and knowledge to evaluate healthcare services and ensure clinically appropriate treatment and evidence-based care are being provided to members.
- Identifies provider best practices.
- Identifies areas for improvement in clinical operations, practices, and/or workflows, and develops quality control practices to optimize patient outcomes.
- Collaborates with Clinical Health provider partners to develop strategies and initiatives aimed at enhancing clinical quality.
- Identifies member safety and risk issues and recommends solutions.
- Applies clinical experience and skills in a collaborative manner with numerous internal stakeholders.
- Active, unencumbered clinical license as an RN or Licensed Mental Health Professional
- Five (5) or more years of experience in direct patient care
- Five (5) or more years of experience in diagnosing and treating mental illness
- Thorough understanding of evidence-based practices
- Extensive managed care experience
- 3 - 5 years of experience in addiction medicine either via outpatient therapy or some more intensive level of SUD treatment
- Behavioral Health experience in reviewing medical records for all levels of care
- Certified Case Manager
- Excellent communication skills
- Registered Nurse (RN) or Licensed Mental Health Professional with active, unencumbered license
- Independently licensed clinical therapist holding an active unencumbered license
40Time Type
Full timePay Range
The typical pay range for this role is:$87,035.00 - $206,206.00This 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.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- 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.