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Aetna Director, Care Coordination and Case Management in Downers Grove, Illinois

Req ID: 63031BR

Job Description

Oversees the care coordination and case management functions for MMAI and Medicaid for the local health plan. Manages field based and office based local care coordination and case management teams. Coordinates business segment policies and procedures in support of financial, operational and service requirements.

Fundamental Components included but are not limited to:

Develop and manage case management and care coordination teams focused on improving clinical and financial outcomes, member engagement and satisfaction and contractual compliance. Serve as liaison with regulatory and accrediting agencies and other health business units. Formulate and implement strategy for achieving applicable department/unit metrics 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. 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:

Experience in government programs managed care, Illinois program; Preferred

Experience with programs serving dual eligible and medically frail populations; Preferred

Proven ability to work in complex matrixed organizations; Required

Ability to synthesize program performance and clinical outcomes; Required

5+ Years clinical leadership experience; Required

Registered Nurse (Masters preferred) or Active unrestricted State Behavioral Health Clinical Licensure in applicable functional area; Required (eg RN, LPC, LCSW) Master's degree in behavioral health field.

Licenses/Certifications:

Mental Health - Licensed Clinical Social Worker, Mental Health - Licensed Professional Counselor, Nursing - Registered Nurse (RN)

Functional Skills:

Clinical / Medical - Management: > 25 employees, Leadership - Lead a major change effortùculture change, Medical Management - Medical Management - Case Management, Medical Management - Medical Management - Managed Care/Insurance Clinical Staff

Technology Experience:

Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Required Skills:

General Business - Demonstrating Business and Industry Acumen, Leadership - Creating Accountability, Leadership - Engaging and Developing People

Desired Skills:

General Business - Maximizing Work Practices, Leadership - Collaborating for Results, Leadership - Driving a Culture of Compliance

Benefit Eligibility

Benefit eligibility may vary by position. Click here to review the benefits associated with this 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.

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