Manager, Clinical Health Services

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Aetna is starting a new Oncology Care Model providing specialized care pathways to our members throughout their oncology treatment.

We are seeking an RN to be the Manager, Clinical Health Services, to lead a variety of direct reports on the Oncology Care Model team including a Nurse Practitioner, Nurse, Pharmacist, Behavioral Health Specialist, and Oncology Companion. The team will partner with an Oncology Medical Director.

This is a fully remote position. Eligible candidates may live anywhere in the contiguous United States.

Responsibilities

• Accountable for the day-to-day management of assigned clinical teams, ensuring adherence to established practices, policies, procedures, and contractual requirements.
• Experience leading clinical operations and building a new multidisciplinary oncology team from the ground up, including onboarding and training staff.
• Lead, develop, and support high-performing clinical teams through effective coaching, performance management, and professional development.
• Participate in the recruitment and hiring process using clearly defined requirements related to education, experience, technical skills, and performance competencies.
• Develop, initiate, monitor, and communicate performance expectations and productivity standards.
• Assess developmental needs and implement action plans that support employee growth and team effectiveness.
• Ensure the successful execution of care management and care coordination activities across the continuum of care.
• Support the management of complex physical and behavioral health cases through clinical guidance, consultation, and collaboration.
• Utilize critical thinking and sound clinical judgment to support appropriate healthcare outcomes and remove barriers to care.
• Provide clinical leadership and support care management staff in delivering culturally competent, member-centered interventions.
• Conduct regular individual and team meetings focused on service delivery, quality outcomes, professional development, and operational performance.
• Collaborate with care managers, medical directors, social support teams, provider partners, and market leadership to achieve business and clinical goals.
• Communicate strategic plans and ensure implementation of tactics that support quality, operational, and financial objectives.
• Evaluate and interpret clinical, operational, and quality performance data to identify opportunities for improvement and implement targeted interventions.
• Identify and escalate quality of care concerns through established channels and drive corrective action when appropriate.
• Champion best practices, innovation, and continuous improvement initiatives that enhance member outcomes and operational effectiveness.
• Serve as a change leader by effectively communicating the business case for change and guiding teams through organizational and operational transformations.
• Maintain compliance with all applicable policies, procedures, regulatory requirements, and contractual obligations.
• May serve as a key point of contact for health plan partners, customers, and internal stakeholders, including participation in customer meetings and implementation initiatives.
• Accountable for achieving clinical, operational, quality, and financial objectives for the assigned team.

Required Qualifications

• Active and unrestricted RN license in their state of residence and have the ability to obtain multi-state licensure upon hire.
• 5+ years of oncology experience.
• Minimum of 2 years of utilization management experience - may include oversight or management of UM activities or teams.
• Demonstrated leadership experience, managing direct reports preferred.
• Knowledge of oncology treatment modalities, supportive care, and symptom management.
• Strong understanding of medical necessity principles and evidence-based clinical guidelines.
• Experience working with multidisciplinary healthcare teams.
• Experience leveraging digital health tools, predictive analytics, AI-enabled workflows.

Preferred Qualifications

• Oncology RN certification through ONCC. Any of the following: OCN, CPHON, CBCN, TCTCN, AOCNP, ROCNTM, AOCNS, AOCN.
• Mastery of problem-solving and decision-making skills.
• Mastery of collaboration and teamwork.
• Mastery of growth mindset (agility and developing yourself and others) skills.
• Mastery of execution and delivery (planning, delivering, and supporting) skills.
• Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option.
• Ability to function in clinical settings with diverse cultural dynamics of clinical staff and patients.
• Mastery knowledge of phases of care transitions and resources available for patients.
• Mastery of digital literacy skills.

Education

• Master’s degree or equivalent* experience – BSN preferred.
• *Equivalent years of experience defined by CVS Policy: If candidate has associate’s degree, additional 4 years of experience is needed. If candidate has bachelor’s degree, an additional 2 years of experience is required.

Anticipated Weekly Hours

• 40

Time Type

• Full-time

Pay Range

• $87,035.00 - $187,460.00

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.