Aetna Program Director, TX STAR Kids in Dallas, Texas
Req ID: 71060BR
At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you ll join a team dedicated to improving the lives of Texas STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.
The STAR Kids Program Director oversees Service Coordination for the STAR Kids implementation and on-going execution of the strategic and operational business plan. Coordinates policies and procedures in support of financial, operational and service requirements. This position is office based in Dallas. This position will require travel 10-20% of the time, per business needs. Required use of a personal vehicle for when traveling in the service areas; must have active and valid TX driver's license, reliable transportation and vehicle insurance. Business mileage is eligible for reimbursement, in accordance with travel policy guidelines.
Fundamental Components included but are not limited to:
Developing and implementing clinical programs and policies.
Enhancing relationships with providers, facilities, plan sponsors, regulatory agencies.
Key business partner in network development, product design, strategic planning and sales support.
Develop and manage clinical operations focused on improving clinical and financial outcomes, member engagement, and satisfaction.
Serve as liaison with regulatory and accrediting agencies and other health business units.
Formulate and implement strategy for achieving applicable department/unit metrics to ensure compliance with regulatory requirements and provide operational direction.
Serve as technical, professional and business resource (may cross multiple business functions).
Develop and participate in presentations and consultations to existing and prospective customers.
Implements and monitors business plan and oversees any implementations or business transitions affecting service operations.
Direct/provide enhancements to business processes, policies and infrastructure to improve operational efficiency (may cross multiple business functions).
Participates in internal and external health industry development efforts.
Develop, implement, and evaluate policies and procedures, which meet business needs (may cross multiple business functions).
Implements and monitors business plan and oversees any implementations or business transitions impacting service operations.
Collaborates and partners with other business areas across/within regions or segments and within other centralized corporate areas to ensure all workflow processes and interdependencies are identified and addressed on an on-going basis.
Promote a clear vision aligned with company values and direction; sets specific challenging and achievable objectives and action plans; motivates others to balance customer needs and business success; challenges self and others to look to the future to create quality products, services, and solutions.
Qualifications Requirements and Preferences:
Registered Nurse (Masters preferred) OR Master's degree in behavioral health field AND Active unrestricted State Licensure in applicable functional area (eg., RN, LCSW, LMSW, LPC, ), is required .
8 or more years clinical leadership or managed care leadership experience is required.
Experience working with Medicaid members is required; experience working with special needs children is preferred.
Previous MCO experience is preferred.
Demonstrated experienced leading and managing operational results using goal setting and performance metrics.
Ability to synthesize program performance and clinical outcomes.
Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
Ability to work with people in such a manner as to build high morale and group commitment to goals and objectives.
Ability to evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes.Ability to communicate effectively with Providers, Members, Staff and other Leaders both in oral and written formats (e.g., may provide support to the sales staff & network staff via onsite customer visits and/or presentations).
Exceptional communication skills, verbal, written and presentation.
Benefit eligibility may vary by position.
Job Function: Healthcare
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.