Senior Principal Clinical Leader – RN, BH
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Job Description
Senior Principal Clinical Leader overseeing Aetna’s Michigan and Illinois integrated-plan care management. Driving compliant operations, quality improvement, vendor relationships, and clinical workforce performance.
Responsibilities:
- Provide strategic leadership and operational oversight for clinical care management across Aetna's Michigan and Illinois Integrated Plans
- Lead strategic growth and enhancement of applicable care management program capabilities
- Inform model of care and workflow best practices for new technology platforms and tools
- Collaborate with executive leadership to develop and implement program strategies meeting business, CMS, federal and state regulations, and accrediting agency requirements
- Integrate care and case management, utilization management, and program operations
- Lead cost savings and quality improvement projects
- Manage projects and programs using formal project plans and collaborative workgroups
- Deliver operational performance and compliance
- Manage relationships with state authorities and develop, vet, and report state compliance and quality measures
- Manage internal and external processes, communications, and results
- Lead policies, procedures, practice guidelines, and alignment of clinical and business processes
- Implement and revise medical management letters for regulatory and accreditation compliance
- Manage vendor relationships and ensure targets and medical management goals are achieved
- Lead recruitment and operating model development for operational growth
- Develop compliant, cost-effective staffing models
- Oversee workforce and operational readiness for clinical system migrations and implementations
- Lead, develop, motivate, and manage a high-performing team
- Lead effectively in a matrixed environment with shared service divisions
- Lead virtually integrated clinical and non-clinical staff across multiple geographic markets
- Foster professional development, mobility, and operational excellence
Requirements:
- Active unrestricted clinical license in applicable functional area (e.g. RN, LCPC, LCSW)
- 10+ years Managed Care experience required
- Medicare and Medicaid experience including LTSS and DSNP highly preferred
- 7+ years of Care Management operations and leadership experience, including leading leaders and developing high-performing teams
- Experience leading change in a growth business
- Experience leading the strategic design, execution, and outcomes management of Care Management programs
- Demonstrated ability to drive clinical and financial performance
- Experience planning, leading and organizing resources of a large and growing team and developing talent
- Ability to synthesize program performance and clinical outcome
- Ability to evaluate and interpret data to develop new programs and processes
- Ability to communicate effectively with internal and external constituents in written and oral format
- If Behavioral Health: Master's degree in a field leading to independent Behavioral Health licensure
- If Registered Nurse: Master's degree or equivalent experience; MSN preferred
- For an associate’s degree, an additional 4 years of experience is needed
- For a bachelor’s degree, an additional 2 years of experience is required
- Eligible candidates may live anywhere in the contiguous United States
Benefits:
- CVS Health bonus, commission or short-term incentive program
- Award target in the company’s equity award program
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
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