Manager, Clinical Health Services – Aetna Medicaid UM Letters Team

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the daily functions of a Medicaid Centralized Letters team.

• Guarantee the precise and timely distribution of member notifications and authorization determination communications.

• Ensure adherence to state contractual obligations, regulatory standards, accreditation criteria, and established turnaround times.

• Track operational performance and analyze data to pinpoint opportunities for process optimization, quality improvement, and enhanced efficiency.

• Collaborate with internal business partners, peer leaders, and external vendors to facilitate effective member communication processes.

• Implement and oversee clinical policies, procedures, and operational practices in line with applicable state, federal, and accreditation mandates.

• Promote continuous improvement initiatives by recognizing and applying best practices that enhance service delivery and operational performance.

• Manage a team of approximately 20 colleagues.

• Cultivate high-performing teams and support strategic initiatives throughout the centralized letters organization.

⛳️ Requirements

• Active, current, and unrestricted RN license in the candidate's state of residence.

• Five years of relevant work experience.

• At least two years of experience in managed care.

• Proven leadership experience in a Team Lead, Supervisor, or higher-level leadership capacity.

• Proficient in Microsoft Office applications, including Outlook, Word, Excel, and PowerPoint.

• Ability to work core business hours, Monday through Friday, from 8:00 AM to 5:00 PM, with flexibility to work occasional weekends as business needs dictate.

• Capacity to extend hours beyond the regular schedule as necessary to achieve business objectives.

• Willingness to travel up to 5% for meetings, audits, and implementation activities.

• Familiarity with Utilization Management and prior authorization processes.

• Experience with state contractual obligations, regulatory guidelines, and member notification compliance in a managed care setting.

• Knowledge of NCQA standards and accreditation requirements.

• Experience collaborating with external vendors to meet operational goals.

• Ability to independently work in a remote environment while effectively interacting with virtual teams.

• Master’s degree or equivalent clinical experience.

• If the candidate holds an associate’s degree, an additional four years of experience is required.

• If the candidate possesses a bachelor’s degree, an additional two years of experience is necessary.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.