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Aetna Director, Clinical Health Services RN Case Management MCO in Richmond, Virginia

Req ID: 61126BR

Job Description

Onsite in Richmond, Virginia.

Managing Medicaid & Medicare contracts.

Leading staff up 120 employees a mix of remote and onsite.

Occasional travel within the state of Virginia.

Typically Monday-Friday schedule.

Fundamental Components included but are not limited to:

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 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:

Ability to synthesize program performance and clinical outcomes

8 years clinical leadership

MCO leadership experience in case management of 100 employees + is highly preferred


Registered Nurse active for the state of Virginia

Active unrestricted State Licensure in applicable functional area. (eg RN,)


Case Management certification preferred


Masters degree preferred


Nursing - Registered Nurse

Functional Skills:

Medical Management - Medical Management - Case Management

Technology Experience:

Desktop Tool - TE Microsoft Excel

Required Skills:

Leadership - Anticipating and Innovating, Leadership - Creating Accountability, Leadership - Driving Strategic and Organizational Agility

Desired Skills:

Leadership - Driving a Culture of Compliance, Leadership - Driving Change, Leadership - Engaging and Developing People

Benefit Eligibility

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

Job Function: Health Care

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.