Remote Hybrid Utilization Management – Senior Manager, OK

CVS Health

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Job ID: 2545250BR
Category: Nurse
Location: Oklahoma City, OK
Remote: Hybrid

Job Description
Business Overview:
Aetna Better Health of Oklahoma, a CVS Health company, embodies the vision to be a trusted health partner in the local Oklahoma communities we serve. We provide a full array of innovative services that enhance overall wellness and improve everyday life for our members. At Aetna Better Health of Oklahoma, we value professional development and career growth. You will work along other colleagues who align on Heart at Work behaviors and bringing your heart to every moment of health. We will support you all the way!

Position Summary:
Qualified candidates must reside in Oklahoma with frequent presence in the Oklahoma City office required. The Utilization Management Sr. Manager is responsible for the operation of the Contractor’s UM functionality in accordance with the requirements of Section 1.8: “Medical Management” of this Contract. This role will serve as a liaison between the Contractor and the State regarding UM functions. This role, in close coordination with other Key Staff, is responsible for ensuring all utilization reviews are in compliance with the terms of the Contract.
This role provides oversight for the implementation and on-going execution of the strategic and operational business plan for the business segment’s clinical operations, inbound/outbound call queue, implementation, and/or plan sponsor operations. Coordinate business segment policies and procedures in support of financial, operational and service requirements. Implements care coordination services provided to plan populations in order to meet specific regulatory requirements and provide holistic bio-psychosocial care to members in a cost-effective manner. As a member of the Key Personnel team for Aetna Better Health of Oklahoma, the candidate will need to travel to required meetings throughout the state.

Fundamental Components:
• Develop and manage clinical operations focused on improving clinical and financial outcomes, member engagement, and satisfaction.
• Serve as liaison with regulatory and accrediting agencies and other health business units Formulate and implement strategy for achieving applicable department/unit metrics and provide operational direction.
• Formulate and implement strategy for achieving applicable department/unit metrics and provide operational direction.
• Serve as technical, professional and business resource (may cross multiple business functions).
• Develop and participate in presentations and consultations to existing and prospective customers.
• Direct/provide enhancements to business processes, policies and infrastructure to improve operational efficiency (may cross multiple business functions).
• Participates in internal and external health industry development efforts.
• Develop, implement, and evaluate policies and procedures, which meet business needs (may cross multiple business functions).
• Implements and monitors business plan and oversees any implementations or business transitions impacting service operations.
• Collaborates and partners with other business areas across/within regions or segments and within other centralized corporate areas to ensure all workflow processes and interdependencies are identified and addressed on an on-going basis.
• Promote a clear vision aligned with company values and direction; sets specific challenging and achievable objectives and action plans; motivates others to balance customer needs and business success; challenges self and others to look to the future to create quality products, services, and solutions.
• Ability to synthesize program performance and clinical outcomes.
• Collaborate with licensed staff from other areas that assist with oversight of clinical staff and activities of licensed personnel.
• Knowledge of the regulations, standards, and policies which relate to medical management.
• Ability to communicate in a highly effective manner with internal and external constituents in both written and oral format.
• Ability to evaluate and interpret data for the purpose of developing new programs and processes to meet business demands.
• Ability to synthesize program performance and clinical outcomes.

Pay Range
The typical pay range for this role is:
Minimum: 97,500
Maximum: 210,000

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

Required Qualifications
• Must reside in Oklahoma with frequent presence in the Oklahoma City office required.
• Oklahoma-licensed RN or Mental Health Professional- Licensed Professional Counselor (LPC), Licensed Marriage & Family Therapist (LMFT), Licensed Behavioral Practitioner (LBP), or Licensed Clinical Social Worker (LCSW) with current unencumbered license.
• Demonstrated experience in Utilization Management.
• 5+ years of clinical practice experience in physical or behavioral healthcare.
• 5+ years of management or clinical leadership.
• 3+ years of experience with personal computer, keyboard navigation, and MS Office Suite applications.
• Must possess reliable transportation and be willing and able to travel in-state up to 20% of the time. Mileage is reimbursed per our company expense reimbursement policy.

Preferred Qualifications
• Certified as a Certified Professional in Health Care Quality by the NAHC or CHCQM by the American Board of Quality Assurance and Utilization Review Providers is preferred.
• Medicaid experience.
• Managed Care experience.
• If RN, MSN degree preferred.

• Bachelor’s degree (BSN) required; OR behavioral health professional with Master’s degree in behavioral practice, social work, counseling, or marriage and family therapy required.

Business Overview
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. 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. 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.