Milford, Massachusetts

Job Description
The Regional Sr Director Clinical Health Services over Care Management is responsible for the oversight of all the CM activity. The Sr. Director ensures the implementation of standardized case management best practices across the assigned Medicaid regions. Acts as primary clinical lead for assigned market(s), including support to the senior leadership team, and serves as the market clinical requirements expert. Depending on the region will be responsible for 2+ states and over 700k members.

Leads the development and oversees the execution of policies and procedures, practice workflow, and data reporting for the Region. Directs the standardization of these functions. Assures quality member care and adheres to all relevant compliance activities. Develops trust, cooperation, and collaboration with administrative, medical staff and departments across the Region.
• Responsible for the oversight and reporting of defined Executive Metrics for assigned regions.
• Collaborates with executive leadership throughout the organization to develop and implement program strategies that meet business, CMS, federal and state regulations as well as accrediting agency requirements
• Identify and develop care management centers of excellence, including maternity/child health, HIV, transplant
• Cross collaborations with commercial and Medicare counterparts in the development and delivery models support business development, growth, and key stakeholder relationships throughout the regions.
• Oversees and ensures that day to day Case Management operations of the assigned Regions are completed in an efficient manner and in accordance with organizational policies and values.
• Demonstrates problem-solving, critical thinking, and prioritization of work and resolves issues as they arise in an appropriate and timely manner.
• Develops and executes on short- and long-term goals for the department consistent with established organization goals and objectives.
• Lead formulation, preparation and communication of strategic business plans Ensure operational alignment to strategy
• Assures comprehensive understanding of internal and external environmental influences Stimulate strategic thinking in support of business direction Develop communication vehicles for presentations/speeches
• Develop issues relative to organization's strategic direction. Identifies issues, coordinates analysis and initiation of corrective action
• Manage special projects that impact entire organization Legislative analysis and response to bills Preparation of advocacy material Exhibits behaviors outlined in
• Creates and maintains collaborative partnerships with key providers (large medical groups, hospitals); works to establish collaborative relationships by fostering excellent customer response and appropriate problem resolution
• Leads a team that promotes high standards of operational practice through advancement of policies, procedures, practice guidelines
• Alignment of clinical and business processes and practices
• Coordinates regional staffing efforts across the region; leads this effort on a day-to-day basis by accessing schedules and real-time information on unexpected staffing gaps such as call offs. Communicates to all case managers (and supervisors) asking for their assistance to fill these staffing gaps across the region.
• Contributes at the most senior level by working across strategic and business units to set, engage and achieve objectives of the organization. Demonstrates the ability to critically evaluate and provide input to areas outside own area of expertise. Acts as a coach and positive role model for staff by establishing and maintaining a safe work environment that fosters positive morale

Required Qualifications
• 5-7 years of experience in managing a team
• 5-7 years leadership experience and technical/functional expertise in several of the following areas: management consulting, financial analysis, project management, public policy, mergers and acquisitions, operations management and/or marketing.
• Previous Medicaid Managed Care experience (5+ years) having worked with state regulators and executed on strategic initiatives and programs
• Demonstrated relationship management skills at the senior levels within an organization and external constituents.
• Demonstrated experience successfully implementing change in complex organizations.
• Experience with enterprise-wide and/or cross-functional large scale initiatives with high degree of complexity.
• Strong leadership experience, strategic vision and a proven ability to execute on clinical initiatives are a “must have” in this position. 5-7 years management or clinical leadership
• Competent in data analysis and uses this to drive medical management strategy
• Knowledge of medical management regulations, standards, and policies
• Ability to evaluate and interpret data for the purpose of developing and revising new programs and processes to meet business demands
• Ability to provide leadership to staff and to build the trust and respect of internal and external key stakeholders. Able to motivate staff and promote team building
• Ability to communicate in a highly effective manner with internal and external constituents in both written and oral format
• Excellent written and verbal communication skills
• Excellent problem-solving skills, including creativity, resourcefulness, timeliness and technical knowledge related to analyzing and resolving medical/administrative problems
• Sensitivity to needs of culturally and linguistically diverse members, caregivers, providers and employee populations
• Exceptional emotional coping skills, adequate to confront difficult emotional situations and emotional responses of others
• This job requires use and exercise of independent judgment

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 30 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 60 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 30 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
Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software

Education
Bachelor’s in Nursing required, or Master’s in Social Work required.
Master’s in Nursing or other related healthcare graduate degree preferred.
Active unrestricted State Licensure in applicable functional area. (e.g. RN, LPC, LCSW)

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. See Job Description

Milford, Massachusetts

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