Sr Manager Clinical Planning and Strategy
CVS Pharmacy - New York City, NY
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Job DescriptionRefine and implement clinical strategy for Aetna's rapidly growing Duals Segment. From your role in the Duals Program Office support Duals growth, expansion, strategy, clinical and administrative operations for Special Needs Plans including DSNPs and MMPs. This position is focused on initiatives that enhance capabilities to manage clinically and socially complex dually eligible and special needs populations. This position will serve as the liaison to enterprise and segment clinical and related operational areas supporting SNPs. The manager will support initiatives that improve the effectiveness and impact of clinical programs and facilitate development and implementation of program enhancements and new initiatives. This manager will collaborate across Aetna's clinical areas to facilitate cross-functional clinical operational design and improvement activities. This leader's responsibilities will include managing the Special Needs Plan Model of Care submission processes, facilitating clinical oversight committees, and analyzing clinical program effectiveness among other duties.Fundamental Components/Job Description: Working with segment and cross-functional management, this leader will work cross-functionally to develop strategies and translate vision into execution of projects and priorities aligned with Duals Segment clinical goals. Serve as liaison supporting the advancement of clinical programs and services to support duals segment performance and enhancing overall capabilities to manage complex populations Work with clinical and related operational areas to identify improvement opportunities Facilitate cross functional planning efforts to formulate and implement strategy for achieving applicable department/unit metrics and provide operational direction to support achievement Support implementation of clinically related initiatives focused on improving clinical and financial outcomes and member and provider engagement and satisfaction Serve as duals subject matter expert for clinical, technical, and other business-related activities Monitor performance and outcomes of new and established programs and servicesRequired Qualifications 5-7 years working with clinical teams Medicare, Medicaid, and DSNP experience including care management and utilization management Demonstrated experience managing change in complex matrix environment Experience understanding Medicare utilization management, Special Needs Plan Model of Care and care management requirements and translating requirement into effective operational models Experience implementing clinical and related operational programs for dual eligible and clinically complex Medicare populations and for understanding Medicare utilization management, Special Needs Plan model of care and care management requirements, and other specialized clinical initiatives Multiple years leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes Experience with Medicaid clinical programs and services including managed long term care services and supports preferred Ability to synthesize program performance and clinical outcomes Demonstrated superior business process, project management and organizational redesign experienceCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsMasters or RN PreferredEducationBA requiredBusiness OverviewBring your heart to CVS HealthEvery 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Created: 2024-09-07