Program Overview Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.
Position Summary The Associate Manager, Clinical Health Service will oversee the implementation of healthcare management services for assigned functional area.
Fundamental Components - Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g., NCQA, URAC, state and federal standards and mandates as applicable)
- Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking
- Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care
- May act as a liaison with other key business areas.
- May develop/assist in development and/review new training content
- May collaborate/deliver inter and intra-departmental training sessions
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality
- Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating, and documenting of care
- Evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes
- Develop, initiate, evaluate, monitor, and communicate performance expectations
- Ensures the team's understanding and use of information system capability and functionality
- Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills
- Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams
- Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance
- Consistently demonstrates the ability to serve as a model change agent and lead change efforts
- Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when needed Accountable for maintaining compliance with policies and procedures and implements them at the employee level
- Communicate effectively with Providers, Members, Staff and other Leaders (e.g., may provide support to the sales staff & network staff via onsite customer visits and/or presentations)
Required Qualifications - Candidate must have an active and unrestricted Registered Nurse (RN) License in the state of residence OR an active and unrestricted Licensed Clinical Social Worker (LCSW) in the state of residence
- 3 - 5 years in clinical area of expertise
- Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
Preferred Qualifications - Managed Medicare experience
- Previous management experience
Education- Associate's Degree in Nursing (REQUIRED)
- Bachelor's Degree in Nursing OR Master's Degree in Behavioral Health Field (PREFERRED)
License- Active and unrestricted Registered Nurse (RN) License in the state of residence OR an active and unrestricted Licensed Clinical Social Worker (LCSW) in the state of residence
Anticipated Weekly Hours40
Time TypeFull time
Pay RangeThe typical pay range for this role is:
$80,340.00 - $173,040.00
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.
Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full-time position is eligible for a 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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 07/30/2026
