Senior Principal Clinical Leader – RN, BH

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

📋 Description

• Provide strategic direction and operational management for clinical care administration across Aetna's Integrated Plans in Michigan and Illinois.

• Drive strategic growth and enhancement of relevant care management program capabilities.

• Advise on the model of care and best practices for workflows concerning new technology platforms and tools.

• Collaborate with executive leadership to formulate and execute program strategies that comply with business, CMS, federal and state regulations, as well as accrediting agency standards.

• Integrate care management, case management, utilization management, and program operations.

• Spearhead cost-saving initiatives and quality improvement projects.

• Oversee projects and programs utilizing structured project plans and collaborative workgroups.

• Deliver on operational performance and compliance objectives.

• Manage relationships with state authorities, while developing, vetting, and reporting on state compliance and quality measures.

• Oversee both internal and external processes, communications, and outcomes.

• Lead the development of policies, procedures, practice guidelines, and ensure alignment of clinical and business processes.

• Implement and update medical management letters to ensure adherence to regulatory and accreditation standards.

• Manage vendor relations to ensure targets and medical management objectives are met.

• Guide recruitment efforts and develop operational models to facilitate growth.

• Create compliant and cost-effective staffing frameworks.

• Supervise workforce and operational preparedness for clinical system migrations and implementations.

• Inspire, develop, and lead a high-performing team.

• Navigate effectively within a matrixed environment sharing service divisions.

• Lead virtually integrated clinical and non-clinical personnel across various geographic markets.

• Promote professional development, mobility, and operational excellence.

⛳️ Requirements

• Active unrestricted clinical license in the relevant functional area (e.g., RN, LCPC, LCSW).

• Minimum of 10 years of experience in Managed Care is required.

• Preferred experience in Medicare and Medicaid, particularly in LTSS and DSNP.

• At least 7 years of operational and leadership experience in Care Management, including mentoring leaders and building high-performing teams.

• Proven track record of leading change within a growing business environment.

• Experience in the strategic design, execution, and outcome management of Care Management programs.

• Demonstrated capability to enhance clinical and financial performance.

• Experience in planning, leading, and organizing resources for a large, expanding team while fostering talent development.

• Ability to consolidate program performance data and clinical outcomes.

• Proficient in evaluating and interpreting data to create new programs and processes.

• Strong communication skills for effective interaction with internal and external stakeholders, both in writing and verbally.

• If in Behavioral Health: Master’s degree in a field that qualifies for independent Behavioral Health licensure.

• If a Registered Nurse: Master’s degree or equivalent experience; MSN preferred.

• For candidates with an associate’s degree, an additional 4 years of experience is required.

• For candidates with a bachelor’s degree, an additional 2 years of experience is required.

• Eligible candidates may reside anywhere in the contiguous United States.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• Target for awards in the company’s equity award program.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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