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Most recent job postings at aetnabetterhealth
via Monster
schedule_type: Full-time
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important... as what we deliver.
Our Heart At Work Behaviors™
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important... as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary:
Join our Aetna Better Health MLTC (Managed Long-Term Care) Assessment Team! The Associate Manager will oversee the implementation of healthcare management services for assigned functional area Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g. state and federal standards and mandates as applicable).
• Serves as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking.
• Ensures 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.
• May develop/assist in development and/review new training content.
• May collaborate/deliver inter and intra-departmental training sessions.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating and documenting of care.
• Develop, initiate, monitor and communicate performance expectations.
• Ensures the team's understanding and use of information system capability and functionality.
• May have responsibility for their own case load work.
• May act as a single point of contact for the customer and the Account Team including: participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.
• Participates 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 an 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.
Required Qualifications:
• Active and unrestricted RN license in the state of NY.
• 3+ years of clinical experience required.
• 2+ years of leadership, management or supervisory experience required.
• 1+ year of experience Microsoft Office Suite applications (Word, Excel, Teams, PowerPoint).
Preferred Qualifications:
• Master’s degree preferred.
• UAS certification preferred.
• 3+ years of Managed care experience preferred.
Education:
Bachelor’s degree is required.
Pay Range
The typical pay range for this role is:
$80,340.00 - $173,000.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through
ColleagueRelations@CVSHealth.com
If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.
About the Company:
CVS Health
CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for all.
Company Size:
10,000 employees or more
Industry:
Biotechnology/Pharmaceuticals
Founded:
0
Website:
https://cvshealth.com Show more details...
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary:
Join our Aetna Better Health MLTC (Managed Long-Term Care) Assessment Team! The Associate Manager will oversee the implementation of healthcare management services for assigned functional area Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g. state and federal standards and mandates as applicable).
• Serves as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking.
• Ensures 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.
• May develop/assist in development and/review new training content.
• May collaborate/deliver inter and intra-departmental training sessions.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating and documenting of care.
• Develop, initiate, monitor and communicate performance expectations.
• Ensures the team's understanding and use of information system capability and functionality.
• May have responsibility for their own case load work.
• May act as a single point of contact for the customer and the Account Team including: participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.
• Participates 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 an 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.
Required Qualifications:
• Active and unrestricted RN license in the state of NY.
• 3+ years of clinical experience required.
• 2+ years of leadership, management or supervisory experience required.
• 1+ year of experience Microsoft Office Suite applications (Word, Excel, Teams, PowerPoint).
Preferred Qualifications:
• Master’s degree preferred.
• UAS certification preferred.
• 3+ years of Managed care experience preferred.
Education:
Bachelor’s degree is required.
Pay Range
The typical pay range for this role is:
$80,340.00 - $173,000.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through
ColleagueRelations@CVSHealth.com
If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.
About the Company:
CVS Health
CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for all.
Company Size:
10,000 employees or more
Industry:
Biotechnology/Pharmaceuticals
Founded:
0
Website:
https://cvshealth.com Show more details...
via Medvocation
schedule_type: Part-time
Aetna Better Health of Maryland (Aetna Medicaid Plan)is looking for a Medical Director to join our team. The Medical Director will provide oversight for medical policy implementation and participate in the development, implementation, and evaluation of clinical/medical programs. This position is an opportunity to get in near the beginning of a new and rapidly growing Medicaid Managed Care Health... Plan. We are looking for a high-energy clinician
Aetna Better Health of Maryland (Aetna Medicaid Plan)is looking for a Medical Director to join our team. The Medical Director will provide oversight for medical policy implementation and participate in the development, implementation, and evaluation of clinical/medical programs. This position is an opportunity to get in near the beginning of a new and rapidly growing Medicaid Managed Care Health... Plan. We are looking for a high-energy clinician leader to work with the Chief Medical Officer to provide support to the Care Management, Utilization Management Community Development and Quality team departments dedicated to caring for our growing membership. Are you ready to join a company that is changing the face of health care across the nation?
Aetna Better Health of Maryland is 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 Maryland Health Choice members. Our vision incorporates community-based health care that addresses the Social Determinants of Health. We value diversity. Align your career goals with Aetna Better Health of Maryland and we will support you all the way. In this role you will: Reinforce clinical philosophy, programs, policies and procedures Perform daily review of individual cases from concurrent review and prior authorization processes, including denial decisions for cases that do not meet established criteria. Provide medical review and support for case management and care coordination staff to ensure optimal care is rendered to our members according to the terms of the benefit members receive. Identify opportunities to implement best practice approaches and introduce innovations to better improve outcomes. Assess Developmental needs and collaborate with others to identify and implement action plans that support the development of high performing teams Show more details...
Aetna Better Health of Maryland is 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 Maryland Health Choice members. Our vision incorporates community-based health care that addresses the Social Determinants of Health. We value diversity. Align your career goals with Aetna Better Health of Maryland and we will support you all the way. In this role you will: Reinforce clinical philosophy, programs, policies and procedures Perform daily review of individual cases from concurrent review and prior authorization processes, including denial decisions for cases that do not meet established criteria. Provide medical review and support for case management and care coordination staff to ensure optimal care is rendered to our members according to the terms of the benefit members receive. Identify opportunities to implement best practice approaches and introduce innovations to better improve outcomes. Assess Developmental needs and collaborate with others to identify and implement action plans that support the development of high performing teams Show more details...
via Medvocation
schedule_type: Part-time
Aetna Better Health of Kansas is looking for an LTSS (long-term services and supports) clinical officer/medical director to join our team. This physician directs healthcare services for individuals of any age with physical, intellectual, and/or developmental disabilities. The LTSS CO/MD oversees and is responsible for all primary physical and behavioral health services provided to individuals receiving LTSS, and to comparable populations enrolled
Aetna Better Health of Kansas is looking for an LTSS (long-term services and supports) clinical officer/medical director to join our team. This physician directs healthcare services for individuals of any age with physical, intellectual, and/or developmental disabilities. The LTSS CO/MD oversees and is responsible for all primary physical and behavioral health services provided to individuals receiving LTSS, and to comparable populations enrolled in KanCare, as well as all clinical activities pertaining to the operation of LTSS programs and services, including preventive care and the management and coordination of primary and other physical health services for these members. The LTSS CO/MD is also responsible for working with the CMO, behavioral health medical director, pharmacy director, and behavioral supports director to ensure integration of physical and behavioral health services and supports and LTSS, as applicable, for individuals in each of these populations, and to oversee... quality improvement initiatives regarding behavioral supports and the appropriate use of psychotropic medications in these individuals
Show more details...
via Workday
schedule_type: Full-timework_from_home: 1
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. Position Summary The Employment Services Specialist is responsible for overseeing employment services and supports for LTSS Programs and services. This position will be responsible for developing and managing a continuum of vocational, employment and business development services to assist Aetna... Better Health of Kansas members (youth and adults) to achieve their employment goals. The Specialist, as a member of the Care Advocate Team (CAT), is responsible for coordination and collaboration with Kansas Workforce Centers, Kansas Rehabilitation Services, and the Kansas Departments of Education, community stakeholders, workforce agencies, and other state entities to facilitate integrated care delivery through a statewide system of care. In addition, the Specialist is responsible for driving service expansion and/or program development needs to increase competitive integrated employment of youth and adults with disabilities. Schedule: Monday - Friday, General Business Hours (Occasional Saturdays as needed) Required Qualifications - Three or more years of experience in developing employment services and supports for persons with disabilities in integrated settings, which includes more than one (1) year experience directing and leading such programs and services. Or as a Workforce Specialist or similar role for a managed health care organization or public or private agency overseeing collaboration with workforce and vocational agencies - Must reside in Kansas - Must be willing to travel up to 25% Preferred Qualifications -Five or more years of experience in public sector, managed health care -Ability to interpret rules, regulations, and policies and to make decisions in accordance with established policies -Must reside in Kansas -Proven track record meeting project dates -Experience in determining eligibility for programs or services or experience is preferred -Excellent verbal, written and presentation skills -Demonstrated proficiency with personal computers, keyboard navigation, and MS Office Suite applications -Knowledge and understanding of the state Medicaid managed care market, regulations, practices and integrated health system strongly preferred Education · Bachelor’s degree in Human Services or related human services field required Pay Range The typical pay range for this role is: $60,300.00 - $132,600.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work. CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area
Show more details...
via Jobs
schedule_type: Full-time and Part-timework_from_home: 1
Industry: Private
Employment Type: Full Time
Work Hours: 8...
Salary: $72000/Yearly
Location: United States
Company: Aetna
Convey your coronary heart to CVS health. Each one people at CVS fitness shares a single, clear cause: Bringing our heart to each second of your fitness. This purpose publications our dedication to deliver stronger human-centric health care for a rapidly changing world. Anchored in our brand ? with coronary heart at its middle
Industry: Private
Employment Type: Full Time
Work Hours: 8...
Salary: $72000/Yearly
Location: United States
Company: Aetna
Convey your coronary heart to CVS health. Each one people at CVS fitness shares a single, clear cause: Bringing our heart to each second of your fitness. This purpose publications our dedication to deliver stronger human-centric health care for a rapidly changing world. Anchored in our brand ? with coronary heart at its middle ? our cause sends a private message that how we deliver our services is simply as critical as what we supply. Aetna Work From Home Jobs (Remote)
Our heart At paintings Behaviors? assist this motive. We need everybody who works at CVS health to sense empowered by using the function they play in remodeling our culture and accelerating our ability to innovate and deliver solutions to make fitness care greater personal, handy and less expensive. Aetna Data Entry Remote Jobs
Function precis
Aetna better health of Oklahoma, a CVS fitness agency, is a depended on health associate within the local Oklahoma groups we serve. We provide a full array of revolutionary offerings that beautify usual wellness and enhance normal existence for our individuals. At Aetna higher health of Oklahoma, we cost professional development and profession growth. You'll paintings along different colleagues who align on heart at paintings behaviors and bringing your heart to each moment of health. We can support you all of the way! Aetna Data Entry Remote Jobs
That is a full-time teleworker possibility in any country (U.S.A.). Oklahoma residency is a plus.
Non-stop best improvement is more than a buzzword ? it's how we meet customer desires and control prices. Via high-quality control specialists, we placed industry-leading practices and ideas to paintings in support of our high-quality goals. This position supports exceptional control method that meets inner and outside constituent expectations and improves member health effects. Aetna Data Entry Remote Jobs
Drives member pleasure via focused, strategic outreach
Develops member campaigns and manages evaluation reviews
Works with supplier control and procurement to implement member outreach campaigns
Establishes and keeps suitable dealer family members
Acts as an advise for, and help, the enterprise via serving as a high-quality champion via measuring and tracking the satisfactory and effectiveness of labor approaches that impact client pleasure, scientific cost management, and operational efficiency.
Seek advice from and/or paintings cross functionally to persuade and sell change on the way to constantly supply first-rate service to our inner and outside clients.
Conduct popular quality evaluations /audits to measure compliance with published rules, strategies, purchaser and regulatory recommendations. Aetna Data Entry Remote Jobs
Identify and distribute errors to business companions
Help with the day-to-day protection and operations of assigned useful unit
Perform analysis of records to perceive and communicate tendencies in the course of day-to-day work
May additionally carry out or assist with special tasks/reviews
Can also offer technical or challenge depend knowledge regarding guidelines, tactics, and characteristic-related programs/systems equipment. Aetna Data Entry Remote Jobs
Required qualifications
2+ years? member outreach, health care advertising, and/or different fitness training experience
Customer service or name middle experience.
Enjoy running with data.
Capability to work independently with a excessive attention to information.
Terrific verbal and written communication skills.
2+ years? enjoy the use of non-public computer, keyboard navigation, navigating more than one systems and programs; and the use of MS workplace Suite packages (teams, Outlook, phrase, Excel, etc.)
Desired qualifications
Bachelor?s degree
QNXT revel in
Task management revel in
Analytic enjoy
Education
Excessive college diploma/GED
Pay variety
The typical pay range for this function is:
$19.Fifty two ? $36.06
This pay range represents the bottom hourly fee or base annual full-time profits for all positions inside the job grade inside which this position falls. The real base income provide will rely upon a ramification of factors including experience, training, geography and other applicable factors. This role is eligible for a CVS fitness bonus, commission or quick-term incentive program similarly to the bottom pay variety indexed above. Aetna Data Entry Remote Jobs
Further in your reimbursement, experience the rewards of an employer that puts our coronary heart into being concerned for our colleagues and our groups. The company gives a full variety of scientific, dental, and imaginative and prescient benefits. Eligible personnel might also sign up in the organisation?s 401(k) retirement financial savings plan, and an worker stock buy Plan is also available for eligible employees. The business enterprise offers a totally-paid term lifestyles coverage plan to eligible personnel, and quick-time period and long term incapacity benefits. CVS health additionally offers numerous nicely-being applications, schooling help, unfastened improvement publications, a CVS store bargain, and bargain packages with participating partners. As for time off, corporation employees revel in Paid day without work (?PTO?) or holiday pay, as well as paid holidays during the calendar year. Variety of paid vacations, ill time and other time off are furnished regular with applicable country regulation and enterprise regulations. Aetna Data Entry Remote Jobs
Aetna is a medical health insurance organization that gives a range of healthcare-related offerings, inclusive of clinical, dental, pharmacy, disability, and other associated fitness merchandise. As of my ultimate update, Aetna, now part of CVS health, gives numerous blessings to its contributors and employees: Aetna Data Entry Remote Jobs
Blessings for individuals:
Health insurance coverage: Aetna offers numerous medical insurance plans, including person and circle of relatives plans, company-subsidized plans, Medicare, and Medicaid.
Network of Healthcare vendors: Aetna usually has a huge network of healthcare providers, inclusive of hospitals, doctors, professionals, and pharmacies, permitting contributors to get right of entry to care without difficulty.
On line tools and sources: They offer digital tools and resources along with cellular apps and on-line portals to assist members control their health, discover providers, take a look at claims, and access educational materials.
Well being applications: Aetna frequently affords well being programs and incentives to encourage wholesome behaviors, which includes health packages, nutrition counseling, and smoking cessation guide.
Telemedicine offerings: some plans offer telemedicine offerings, permitting contributors to consult with healthcare specialists remotely for certain non-emergency situations. Aetna Data Entry Remote Jobs
Blessings for employees:
Fitness and well being packages: Aetna typically offers comprehensive fitness and wellbeing applications for its personnel, including get admission to healthcare, health incentives, and health coaching.
Work-existence balance: They often provide bendy paintings preparations, paid time without work, and guide for personnel to achieve a healthy paintings-existence stability.
Career development: Aetna commonly invests in worker education and development applications to assist personnel develop of their careers.
Economic benefits: this might include retirement financial savings plans, lifestyles insurance, disability insurance, and worker help programs.
Network Engagement: some businesses, which includes Aetna, inspire network involvement through supporting volunteer applications and charitable projects.Aetna is a health insurance company that offers a number healthcare-associated offerings, including medical, dental, pharmacy, incapacity, and different associated fitness products. As of my last replace, Aetna, now part of CVS fitness, gives diverse blessings to its contributors and personnel: Aetna Data Entry Remote Jobs
Apply Job Show more details...
Employment Type: Full Time
Work Hours: 8...
Salary: $72000/Yearly
Location: United States
Company: Aetna
Convey your coronary heart to CVS health. Each one people at CVS fitness shares a single, clear cause: Bringing our heart to each second of your fitness. This purpose publications our dedication to deliver stronger human-centric health care for a rapidly changing world. Anchored in our brand ? with coronary heart at its middle ? our cause sends a private message that how we deliver our services is simply as critical as what we supply. Aetna Work From Home Jobs (Remote)
Our heart At paintings Behaviors? assist this motive. We need everybody who works at CVS health to sense empowered by using the function they play in remodeling our culture and accelerating our ability to innovate and deliver solutions to make fitness care greater personal, handy and less expensive. Aetna Data Entry Remote Jobs
Function precis
Aetna better health of Oklahoma, a CVS fitness agency, is a depended on health associate within the local Oklahoma groups we serve. We provide a full array of revolutionary offerings that beautify usual wellness and enhance normal existence for our individuals. At Aetna higher health of Oklahoma, we cost professional development and profession growth. You'll paintings along different colleagues who align on heart at paintings behaviors and bringing your heart to each moment of health. We can support you all of the way! Aetna Data Entry Remote Jobs
That is a full-time teleworker possibility in any country (U.S.A.). Oklahoma residency is a plus.
Non-stop best improvement is more than a buzzword ? it's how we meet customer desires and control prices. Via high-quality control specialists, we placed industry-leading practices and ideas to paintings in support of our high-quality goals. This position supports exceptional control method that meets inner and outside constituent expectations and improves member health effects. Aetna Data Entry Remote Jobs
Drives member pleasure via focused, strategic outreach
Develops member campaigns and manages evaluation reviews
Works with supplier control and procurement to implement member outreach campaigns
Establishes and keeps suitable dealer family members
Acts as an advise for, and help, the enterprise via serving as a high-quality champion via measuring and tracking the satisfactory and effectiveness of labor approaches that impact client pleasure, scientific cost management, and operational efficiency.
Seek advice from and/or paintings cross functionally to persuade and sell change on the way to constantly supply first-rate service to our inner and outside clients.
Conduct popular quality evaluations /audits to measure compliance with published rules, strategies, purchaser and regulatory recommendations. Aetna Data Entry Remote Jobs
Identify and distribute errors to business companions
Help with the day-to-day protection and operations of assigned useful unit
Perform analysis of records to perceive and communicate tendencies in the course of day-to-day work
May additionally carry out or assist with special tasks/reviews
Can also offer technical or challenge depend knowledge regarding guidelines, tactics, and characteristic-related programs/systems equipment. Aetna Data Entry Remote Jobs
Required qualifications
2+ years? member outreach, health care advertising, and/or different fitness training experience
Customer service or name middle experience.
Enjoy running with data.
Capability to work independently with a excessive attention to information.
Terrific verbal and written communication skills.
2+ years? enjoy the use of non-public computer, keyboard navigation, navigating more than one systems and programs; and the use of MS workplace Suite packages (teams, Outlook, phrase, Excel, etc.)
Desired qualifications
Bachelor?s degree
QNXT revel in
Task management revel in
Analytic enjoy
Education
Excessive college diploma/GED
Pay variety
The typical pay range for this function is:
$19.Fifty two ? $36.06
This pay range represents the bottom hourly fee or base annual full-time profits for all positions inside the job grade inside which this position falls. The real base income provide will rely upon a ramification of factors including experience, training, geography and other applicable factors. This role is eligible for a CVS fitness bonus, commission or quick-term incentive program similarly to the bottom pay variety indexed above. Aetna Data Entry Remote Jobs
Further in your reimbursement, experience the rewards of an employer that puts our coronary heart into being concerned for our colleagues and our groups. The company gives a full variety of scientific, dental, and imaginative and prescient benefits. Eligible personnel might also sign up in the organisation?s 401(k) retirement financial savings plan, and an worker stock buy Plan is also available for eligible employees. The business enterprise offers a totally-paid term lifestyles coverage plan to eligible personnel, and quick-time period and long term incapacity benefits. CVS health additionally offers numerous nicely-being applications, schooling help, unfastened improvement publications, a CVS store bargain, and bargain packages with participating partners. As for time off, corporation employees revel in Paid day without work (?PTO?) or holiday pay, as well as paid holidays during the calendar year. Variety of paid vacations, ill time and other time off are furnished regular with applicable country regulation and enterprise regulations. Aetna Data Entry Remote Jobs
Aetna is a medical health insurance organization that gives a range of healthcare-related offerings, inclusive of clinical, dental, pharmacy, disability, and other associated fitness merchandise. As of my ultimate update, Aetna, now part of CVS health, gives numerous blessings to its contributors and employees: Aetna Data Entry Remote Jobs
Blessings for individuals:
Health insurance coverage: Aetna offers numerous medical insurance plans, including person and circle of relatives plans, company-subsidized plans, Medicare, and Medicaid.
Network of Healthcare vendors: Aetna usually has a huge network of healthcare providers, inclusive of hospitals, doctors, professionals, and pharmacies, permitting contributors to get right of entry to care without difficulty.
On line tools and sources: They offer digital tools and resources along with cellular apps and on-line portals to assist members control their health, discover providers, take a look at claims, and access educational materials.
Well being applications: Aetna frequently affords well being programs and incentives to encourage wholesome behaviors, which includes health packages, nutrition counseling, and smoking cessation guide.
Telemedicine offerings: some plans offer telemedicine offerings, permitting contributors to consult with healthcare specialists remotely for certain non-emergency situations. Aetna Data Entry Remote Jobs
Blessings for employees:
Fitness and well being packages: Aetna typically offers comprehensive fitness and wellbeing applications for its personnel, including get admission to healthcare, health incentives, and health coaching.
Work-existence balance: They often provide bendy paintings preparations, paid time without work, and guide for personnel to achieve a healthy paintings-existence stability.
Career development: Aetna commonly invests in worker education and development applications to assist personnel develop of their careers.
Economic benefits: this might include retirement financial savings plans, lifestyles insurance, disability insurance, and worker help programs.
Network Engagement: some businesses, which includes Aetna, inspire network involvement through supporting volunteer applications and charitable projects.Aetna is a health insurance company that offers a number healthcare-associated offerings, including medical, dental, pharmacy, incapacity, and different associated fitness products. As of my last replace, Aetna, now part of CVS fitness, gives diverse blessings to its contributors and personnel: Aetna Data Entry Remote Jobs
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via Adzuna
posted_at: 26 days agoschedule_type: Full-time
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important... as what we deliver. Our Heart At Work Behaviors support
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important... as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary The FP&A Analyst position has responsibilities in several key areas on the ABH Kansas Finance team, primarily in the areas of SG&A and FTE reporting and planning, month end close, and AP / check run oversight. This position will work cross-functionally to manage, plan, and report on the above. Required Qualifications
- 1+ years of experience in an accounting or finance role
- 1+ years of experience with Microsoft Excel
- 1+ years of experience of Generally Accepted Accounting Principles (can be through education)
Preferred Qualifications
- Ability to work independently and to multitask under tight deadlines
- Experience with Hyperion, Oracle, Ariba- Experience working for a large public company
- Knowledge of health insurance industry terminology and concepts- Comfortable speaking to Senior Management and Executive LeadershipEducation
Bachelor's degree required. Bachelor's degree in Finance, Accounting, or Mathematics is preferred.
Pay Range
The typical pay range for this role is:
$40,600.00 - $85,100.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution Show more details...
Position Summary The FP&A Analyst position has responsibilities in several key areas on the ABH Kansas Finance team, primarily in the areas of SG&A and FTE reporting and planning, month end close, and AP / check run oversight. This position will work cross-functionally to manage, plan, and report on the above. Required Qualifications
- 1+ years of experience in an accounting or finance role
- 1+ years of experience with Microsoft Excel
- 1+ years of experience of Generally Accepted Accounting Principles (can be through education)
Preferred Qualifications
- Ability to work independently and to multitask under tight deadlines
- Experience with Hyperion, Oracle, Ariba- Experience working for a large public company
- Knowledge of health insurance industry terminology and concepts- Comfortable speaking to Senior Management and Executive LeadershipEducation
Bachelor's degree required. Bachelor's degree in Finance, Accounting, or Mathematics is preferred.
Pay Range
The typical pay range for this role is:
$40,600.00 - $85,100.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution Show more details...
via Fort Campbell, KY - Geebo
posted_at: 3 days agoschedule_type: Full-timesalary: 20–28 an hour
Position
Summary:
Aetna Better Health of Kentucky (Kentucky Medicaid Plan) is looking for two (2) Medical Directors to join our team. The Medical Director will provide oversight for medical policy implementation and participate in the development, implementation, and evaluation of clinical/medical programs. Both positions are open due to current Medical Directors being eligible for Early... Retirement Program. Some telework may be allowed once fully
Position
Summary:
Aetna Better Health of Kentucky (Kentucky Medicaid Plan) is looking for two (2) Medical Directors to join our team. The Medical Director will provide oversight for medical policy implementation and participate in the development, implementation, and evaluation of clinical/medical programs. Both positions are open due to current Medical Directors being eligible for Early... Retirement Program. Some telework may be allowed once fully trained but the position is primarily office based.
In this role you will:
Reinforce clinical philosophy, programs, policies and procedures
Perform daily review of individual cases from concurrent review and prior authorization processes, including denial decisions for cases that do not meet established criteria.
Provide medical review and support for case management and care coordination staff to ensure optimal care is rendered to our members according to the terms of the benefit members receive.
Communicate strategic plan and specific tactics to meet plan.
Ensure implementation of tactics to meet strategic direction for cost and quality outcomes.
Create direction and communicate a business case for change by focusing on and addressing key priorities to achieve business results.
Identify opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
Be accountable for meeting the financial, operational and quality objectives of the unit.
Develop, initiate, monitor and communicate performance expectations.
Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills.
Assess developmental needs and collaborate with others to identify and implement action plans that support the development of high performing teams.
Consistently demonstrate the ability to serve as a model change agent and lead change efforts.
Be responsible for maintaining compliance with policies and procedures and implements them at the employee level.
Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.
Background /
Experience:
2-3 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
Previous managed care experience with an insurer / payer highly preferred.
Education:
The highest level of education desired for candidates in this position is an MD or DO.
License and Certifications:
M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.Active and current state medical license without encumbrances
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications Show more details...
Summary:
Aetna Better Health of Kentucky (Kentucky Medicaid Plan) is looking for two (2) Medical Directors to join our team. The Medical Director will provide oversight for medical policy implementation and participate in the development, implementation, and evaluation of clinical/medical programs. Both positions are open due to current Medical Directors being eligible for Early... Retirement Program. Some telework may be allowed once fully trained but the position is primarily office based.
In this role you will:
Reinforce clinical philosophy, programs, policies and procedures
Perform daily review of individual cases from concurrent review and prior authorization processes, including denial decisions for cases that do not meet established criteria.
Provide medical review and support for case management and care coordination staff to ensure optimal care is rendered to our members according to the terms of the benefit members receive.
Communicate strategic plan and specific tactics to meet plan.
Ensure implementation of tactics to meet strategic direction for cost and quality outcomes.
Create direction and communicate a business case for change by focusing on and addressing key priorities to achieve business results.
Identify opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
Be accountable for meeting the financial, operational and quality objectives of the unit.
Develop, initiate, monitor and communicate performance expectations.
Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills.
Assess developmental needs and collaborate with others to identify and implement action plans that support the development of high performing teams.
Consistently demonstrate the ability to serve as a model change agent and lead change efforts.
Be responsible for maintaining compliance with policies and procedures and implements them at the employee level.
Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.
Background /
Experience:
2-3 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
Previous managed care experience with an insurer / payer highly preferred.
Education:
The highest level of education desired for candidates in this position is an MD or DO.
License and Certifications:
M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.Active and current state medical license without encumbrances
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications Show more details...
via Workday
schedule_type: Full-timework_from_home: 1
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. Position Summary Aetna Better Health of IL MMAI is a MMP that contracts with the State of Illinois and CMS to serve dually eligible individuals. We are seeking a Sr. Manager to oversee our local provider relations and community outreach staff as well as support overall market performance and... growth by collaborating with key enterprise, market, and segment leadership. To be successful in this position, the candidate must have demonstrated experience in Medicaid and Medicare, developing dual (specifically DSNP) growth strategies, in managing performance, state strategy, regulatory requirements, and teams of field-based staff. The successful candidate will have a demonstrated ability to work in a highly matrixed organization and proven success in such an environment. Required Qualifications - At least 5 years of leadership experience managing diverse teams - Excellent interpersonal skills and the ability to work with others at all levels - Strong analytical and problem-solving skills - Knowledge of Medicare and Medicaid program requirements - Some operational background within a health plan environment - Demonstrated ability to effectively coordinate multiple projects simultaneously - Candidates must be located in Illinois Preferred Qualifications - Experience leading community outreach or provider facing teams - Experience working and communicating with providers - Proficient in Microsoft Office STE, One Note & Teams - Experience working in a heavily matrixed environment Education Bachelor’s degree in a closely related field or an equivalent combination of formal education and recent, related experience Pay Range The typical pay range for this role is: $79,200.00 - $174,200.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work. CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area
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via Austin, TX - Geebo
posted_at: 2 days agoschedule_type: Full-timesalary: 20–28 an hour
Job Description Aetna Better Health of Texas (ABHTX) is searching for a Sr Director, Health Services Operations, to be known at the health plan as Health Services Oversight Officer. The role will report to the CEO and serves as a critical member of the health plan leadership team. This role is a peer to the health plan COO, CFO and CMO in ensuring our health plan health services function is... optimally competitive in the Texas Medicaid and CHIP markets.
Job Description Aetna Better Health of Texas (ABHTX) is searching for a Sr Director, Health Services Operations, to be known at the health plan as Health Services Oversight Officer. The role will report to the CEO and serves as a critical member of the health plan leadership team. This role is a peer to the health plan COO, CFO and CMO in ensuring our health plan health services function is... optimally competitive in the Texas Medicaid and CHIP markets. The right candidate will have the drive, expertise, executive presence, and business acumen to maintain operational excellence through matrixed leadership and oversight of our medical management functions. This is an individual contributor role and the right candidate will know how to effectively lead teams without having a direct reporting relationship. Subject Matter Expertise will be demonstrated by the successful depth of experience in medical management operations, including UM, CM, Service Coordination, and care program development and implementation, SDOH programs, Behavioral
Physical Health integration, and the importance of Quality integration at every level. Your professional experience will demonstrate relevance to the Medicaid program and the Texas regulatory environment. Just as significantly, you are able to demonstrate a thorough understanding of managed care concepts and mechanisms. You possess executive-level presentation skills and can communicate complex concepts in an audience-appropriate manner within the organization, are comfortable meeting with external stakeholders, such as providers, as needed; and understand this role as the accountable contact for all health services operations. Core job duties:
1. For all health services operations issues relevant to the health plan, this role is the leader representing the health plan to shared services and the enterprise broadly. You will ensure the organization understands Texas needs, compliance benchmarks and timelines. You will work closely with the organization to ensure the organization delivers on these needs. 2. This role, through effective oversight, will ensure successful communication, analysis, management, execution, monitoring and staffing for all health services operations impacting the health plan. 3. This role serves as the SPOC on health services operations (CM, UM, all related programs) between the health plan and the regulators. This role represents the health plan as the health services SME for all external and regulatory stakeholders related to CM, UM, and Service Coordination functions. This role represents the health plan as the health services SME for all Plan-specific RFP activity. 4. This role identifies the compliance processes needed to ensure we meet all standards in our Medicaid & CHIP Contracts, such as monitoring report owners and the timely quality review of these reports and works with functional owners and Compliance to ensure overall compliance of processes. Required Qualifications 7-10 years' experience in managed care, Medicaid (MMA+LTSS), CHIP and, the Texas regulatory environment Must have fluency in data analytics COVID Requirements COVID-19 Vaccination Requirement CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated. If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health. If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated. Preferred Qualifications 7-10 years' experience in managed care, Medicaid (MMA+LTSS), CHIP and, the Texas regulatory environment Must have fluency in data analytics Education Masters degree preferred Business Overview At Aetna, a CVS Health company, we are joined in a common purpose:
helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart. We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
Salary Range:
$100K -- $150K
Minimum Qualification
Allied Health ProfessionalsEstimated Salary: $20 to $28 per hour based on qualifications Show more details...
Physical Health integration, and the importance of Quality integration at every level. Your professional experience will demonstrate relevance to the Medicaid program and the Texas regulatory environment. Just as significantly, you are able to demonstrate a thorough understanding of managed care concepts and mechanisms. You possess executive-level presentation skills and can communicate complex concepts in an audience-appropriate manner within the organization, are comfortable meeting with external stakeholders, such as providers, as needed; and understand this role as the accountable contact for all health services operations. Core job duties:
1. For all health services operations issues relevant to the health plan, this role is the leader representing the health plan to shared services and the enterprise broadly. You will ensure the organization understands Texas needs, compliance benchmarks and timelines. You will work closely with the organization to ensure the organization delivers on these needs. 2. This role, through effective oversight, will ensure successful communication, analysis, management, execution, monitoring and staffing for all health services operations impacting the health plan. 3. This role serves as the SPOC on health services operations (CM, UM, all related programs) between the health plan and the regulators. This role represents the health plan as the health services SME for all external and regulatory stakeholders related to CM, UM, and Service Coordination functions. This role represents the health plan as the health services SME for all Plan-specific RFP activity. 4. This role identifies the compliance processes needed to ensure we meet all standards in our Medicaid & CHIP Contracts, such as monitoring report owners and the timely quality review of these reports and works with functional owners and Compliance to ensure overall compliance of processes. Required Qualifications 7-10 years' experience in managed care, Medicaid (MMA+LTSS), CHIP and, the Texas regulatory environment Must have fluency in data analytics COVID Requirements COVID-19 Vaccination Requirement CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated. If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health. If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated. Preferred Qualifications 7-10 years' experience in managed care, Medicaid (MMA+LTSS), CHIP and, the Texas regulatory environment Must have fluency in data analytics Education Masters degree preferred Business Overview At Aetna, a CVS Health company, we are joined in a common purpose:
helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart. We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
Salary Range:
$100K -- $150K
Minimum Qualification
Allied Health ProfessionalsEstimated Salary: $20 to $28 per hour based on qualifications Show more details...
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