Director Case Management - Aetna Better Health of Oklahoma - RN

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Position Summary

The Director of Care Management is a key member of the Aetna Better Health of Oklahoma leadership team. This role oversees the implementation and execution of the strategic and operational business plan for clinical operations. The Director ensures compliance with Oklahoma regulatory requirements while delivering holistic, cost-effective, bio-psychosocial care to members through care management and coordination services. The Director Case Management reports to the Senior Principal Clinical Leader.

Position Responsibilities

• Lead the clinical team to ensure timely health risk screenings, comprehensive assessments, care plan development, and member interventions in alignment with Aetna Better Health Risk Stratification Framework and Oklahoma contractual requirements.
• Develop and manage clinical operations to improve clinical and financial outcomes, member engagement, satisfaction, and adherence to best practices and standards.
• Serve as liaison with regulatory and accrediting agencies and other health business units.
• Formulate and implement strategies to achieve departmental metrics and provide operational direction.
• Integrate care coordination and case management with core business functions, including claims, member services, compliance, quality, utilization management, and provider services.
• Support quality improvement initiatives and oversee successful implementation.
• Direct enhancements to business processes, policies, and infrastructure to improve clinical operational efficiency.
• Develop and evaluate policies and procedures to meet business needs.
• Implement and monitor business plans and oversee transitions impacting clinical operations.
• Collaborate with internal teams and corporate areas to ensure workflow processes and interdependencies are addressed.
• Analyze program performance and clinical outcomes to inform decision-making.
• Promote a clear vision aligned with company values; set challenging objectives and motivate teams to achieve results.
• Communicate effectively with internal and external stakeholders in both written and oral formats.
• Evaluate and interpret data to monitor staff performance, ensure regulatory compliance, and develop new programs and processes.
• Assess team development needs and implement action plans to build high-performing teams.
• Conduct administrative duties in accordance with established standards for team management.

• Active and unrestricted Oklahoma Registered Nurse (RN) license
• Minimum 10 years of clinical practice experience
• At least 5 years of management or clinical leadership, including oversight of case management leaders
• 5 years of case management experience
• Managed care experience (Medicaid strongly preferred; commercial or Medicare experience acceptable)
• 3+ years of proficiency with personal computer use, keyboard navigation, and MS Office Suite
• Nationally recognized case management certification (required or must be obtained within 90 days of employment)

Education

Master’s degree or equivalent experience (BSN preferred)

Pay Range

The typical pay range for this role is:

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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.