Director of Care Management - Aetna Better Health Louisiana (Remote)

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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 Louisiana, the candidate will need to travel to required meetings throughout the state.

Fully remote. Eligible candidates can live anywhere in the US.

Fundamental Components

• Lead 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 …