At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

POSITION SUMMARY

Join our Aetna team as an industry leader in serving Medicaid populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Medicaid members who present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs.
The Associate Manager, Clinical Health Services will be accountable to lead a team of care managers in the Integrated Care Management NJ department primarily remotely, but with some face to face and field visits required. The Associate Manager is a dynamic leader who inspires and motivates their team by taking initiative, leading by example, and maintaining a positive outlook. This role requires a constant state of readiness, a drive for independent learning, and the ability to navigate and resolve challenging situations with confidence and composure. In this role, organization is paramount- you will be responsible for managing multiple competing priorities and meet deadlines.
The Associate Manager will be responsible to lead their team to ensure enterprise and contractual compliance. The Associate Manager will have a strong leadership skillset to lead a dynamic team of case managers with proven experience in change management. We are seeking a leader who is forward thinking, inspires trust, and champions positive change. This role additionally requires a commitment to integrity, transparency, and accountability, as well as the ability to lead teams through transformation with empathy and vision.

What will you do/ Fundamental Components:

• Proactively identify opportunities for improvement and take initiative to implement solutions.
• Lead with heart by fostering a supportive, inclusive, and motivating team environment.
• Maintain a positive attitude, even in the face of adversity, and encourage the same in others.
• Stay prepared for change and adapt quickly to evolving business needs and priorities.
• Demonstrate a commitment to continuous learning and self-development, seeking out new knowledge and skills independently.
• Anticipate and effectively navigate challenging situations, using sound judgment and resilience.
• Communicate clearly and openly with team members, peers, and leadership.
• Support organizational goals by aligning team efforts with company values and objectives.
• Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g., NCQA, URAC, state and federal standards and mandates as applicable)
• Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking
• Ensure implementation and monitoring of best practice approaches and innovations to better address the member’s needs across the continuum of care
• May act as a liaison with other key business areas.
• Will be responsible to develop/assist in development and/review new training content
• Will be responsible to collaborate/deliver inter and intra-departmental training sessions
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality
• Manages a team of case managers and is responsible for oversight of identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating, and documenting of care with potential of carrying a caseload if needed dependent upon business needs/changes.
• Evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes
• Develop, initiate, evaluate, monitor, and communicate performance expectations
• Ensures the team’s understanding and use of information system capability and functionality
• Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills
• Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams
• Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance
• Consistently demonstrates the ability to serve as a model change agent and lead change efforts
• Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when needed
• Accountable for maintaining compliance with policies and procedures and implements them at the employee level
• Communicate effectively with Providers, Members, Staff and other Leaders (e.g., may provide support to the sales staff & network staff via onsite customer visits and/or presentations)
• This position may require up to 50-75% travel to complete Face to Face visits/Observational Audits of Case Managers in the state of NJ in various settings including, but not limited to in homes, hospitals, provider settings, etc. Travel requirements are subject to change based upon business needs.

REQUIRED QUALIFICATIONS

• Field/Remote based position.
• Must possess reliable transportation and be willing and able to travel up to 50% of the time. Mileage is reimbursed per our company expense reimbursement policy
• 3+ years’ experience in clinical area of expertise as a Registered Nurse
• 3+ years work experience in pediatric, special needs and adult population
• 3+ years of care management experience
• 1+ year of discharge planning and/or home health care coordination experience
• 2+ years of leadership experience managing a team (Clinical Team Lead etc.)
• RN with current unrestricted state licensure in the State of New Jersey
• Reliable transportation required to conduct observational face to face audits in the field, assist/mentor case managers in the field as needed face to face. (Mileage is reimbursed per our company expense reimbursement policy)
• Proficient computer literacy and demonstrated proficiency to navigate internal/external computer systems, MS Office Suite applications, etc.
• Proficient in data gathering and interpretation to formulate next steps
• Exceptional organizational skills, flexible, and ability to adapt and embrace change in a fast-paced environment
• Ability to critically think and navigate challenging situations independently
• Ability to prioritize competing priorities and meet deadlines independently
• Self-motivated and dependable
• Positive, forward-thinking mindset
• Exceptional communication skills, both verbally and in writing with ability to adapt delivery methods as needed to ensure all parties understand intended message
• Strong foundational understanding of compliance and independently motivated to learn and acclimate to departmental needs/compliance/SOP’s/Contract Review
• Attention to detail
• Proficient in independently navigating technological needs, virtual platforms, internet connectivity, etc.
• Highly motivated and strategic thinker that thinks outside the box
• Excellent analytical and problem-solving skills

PREFERRED QUALIFICATIONS

• 2+ years’ leadership case management experience within a managed care organization
• Behavioral Health Experience
• Certified Case Manager (CCM)
• Proficiency with learning and navigating care management systems
• Excellent analytical and problem-solving skills

EDUCATION

• Bachelor’s Degree in Nursing (REQUIRED)

• Proactively identify opportunities for improvement and take initiative to implement solutions.
• Lead with heart by fostering a supportive, inclusive, and motivating team environment.
• Maintain a positive attitude, even in the face of adversity, and encourage the same in others.
• Stay prepared for change and adapt quickly to evolving business needs and priorities.
• Demonstrate a commitment to continuous learning and self-development, seeking out new knowledge and skills independently.
• Anticipate and effectively navigate challenging situations, using sound judgment and resilience.
• Communicate clearly and openly with team members, peers, and leadership.
• Support organizational goals by aligning team efforts with company values and objectives.
• Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g., NCQA, URAC, state and federal standards and mandates as applicable)
• Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking
• Ensure implementation and monitoring of best practice approaches and innovations to better address the member’s needs across the continuum of care
• May act as a liaison with other key business areas.
• Will be responsible to develop/assist in development and/review new training content
• Will be responsible to collaborate/deliver inter and intra-departmental training sessions
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality
• Manages a team of case managers and is responsible for oversight of identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating, and documenting of care with potential of carrying a caseload if needed dependent upon business needs/changes.
• Evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes
• Develop, initiate, evaluate, monitor, and communicate performance expectations
• Ensures the team’s understanding and use of information system capability and functionality
• Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills
• Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams
• Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance
• Consistently demonstrates the ability to serve as a model change agent and lead change efforts
• Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when needed
• Accountable for maintaining compliance with policies and procedures and implements them at the employee level
• Communicate effectively with Providers, Members, Staff and other Leaders (e.g., may provide support to the sales staff & network staff via onsite customer visits and/or presentations)
• This position may require up to 50-75% travel to complete Face to Face visits/Observational Audits of Case Managers in the state of NJ in various settings including, but not limited to in homes, hospitals, provider settings, etc. Travel requirements are subject to change based upon business needs