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Refine and implement an integrated Behavioral Health clinical strategy from your leadership role in Aetna’s rapidly growing Duals Segment. Support Duals growth expansion, strategy, clinical and operational alignment for Special Needs Plans including DSNPs and MMPs. This position is responsible for the behavioral health strategy for Aetna’s Duals segment program. This position is focused on refining the strategy to integrate behavioral health needs within a holistic clinical model and developing initiatives that enhance our capabilities to manage clinically and socially complex dually eligible and special needs populations. This leader will work cross-functionally across the enterprise and segment teams to develop and drive initiatives that improve the effectiveness and impact of the behavioral health component of the integrated clinical model and facilitate development and implementation of program enhancements and new initiatives.
Responsibilities will include relationship management, strategy development and execution, regulatory process oversight including quality and model of care related processes, and operational alignment / issue resolution.
To be successful in this position, the candidate must have demonstrated experience with designing and enhancing behavioral health programs in dual eligible populations. Lead strategic integration and ongoing enhancement of clinical programs and initiatives and utilization management for dual eligible members including social determinants of health.
• Serve as the behavioral health champion and organizational SME for products and programs designed for Aetna’s dually eligible Medicare members.
• Collaborate with executive leadership throughout the organization to develop and implement program strategies that meet business needs, federal/state regulations and accrediting agency requirements for dual eligible members
• Work with cross functionally within Medicare and Duals Segment operations and reporting to identify improvement opportunities
• Participates in MOC and quality committee reporting for Duals Segment
• Serve as clinical, technical, professional, and business resource and Duals market subject matter expert
• Develop and participate in presentations and consultations to internal and external audiences
• Monitor performance and outcomes of new and established programs and services
• Maintain national stakeholder relationships critical to thought leadership innovation and policy
• Facilitates diverse internal and external networks, as appropriate, for data gathering and best practice identification. Leverages internal and external networking to drive optimal initiative results and knowledge/best practice transfer
• Provides oversight to or drives initiative planning as required. Designs, develops interventions and facilitates work sessions. Develops and delivers all required analysis, reporting and presentation materials
• Gathers, analyzes, and synthesizes competitive intelligence to drive achievement of strategic business objectives
• 8+ years of experience in Medicaid and or Medicare program operations
• 5+ years management and/or organizational leadership
• Experience working with dual eligible and complex populations
• Experience with development and improvement of integrated behavioral health models for complex populations
• Multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes
• Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously.
• Experience with enterprise-wide and/or cross-functional large-scale initiatives with high degree of complexity.
• Demonstrated ability to successfully implement change amongst cross-functional teams
• Demonstrated ability to synthesize and communicate program performance and outcomes
• Demonstrated superior business process, project management and organizational redesign experience
COVID-19 Vaccination Requirement
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.
Master’s Degree in Clinical Psychology or Social Work preferred
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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.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.