Title LTSS Director, Clinical Health Services
Position Summary This position is a telework position with up to 25% travel required for meeting members in mainly Central and southeast Florida and to attend out-of-state summits as needed. Strongly prefers candidates from Tampa or central or southeast Florida.
The LTSS Director will partner closely with the LTSS Executive Director, Market CEO, and State Medicaid agency to build a transparent and trusting relationship while meeting state objectives.
The Director will collaborate across the enterprise to ensure that the State LTSS program and Aetna objectives are aligned, business strategies are delivered and financial, compliance and quality objectives are met.
The LTSS Director will partner closely with the LTSS Executive Director, Market CEO, and State Medicaid agency to build a transparent and trusting relationship while meeting state objectives.
The Director will collaborate across the enterprise to ensure that the State LTSS program and Aetna objectives are aligned, business strategies are delivered and financial, compliance and quality objectives are met.
Manage staff and develop workforce and organization
Lead, develop, and motivate a high performing team to meet organizational goals and objectives while effectively managing change. Ensure that processes are aligned with the highest quality standards required by Accreditation and Credentialing Organizations (for example, NCQA). Oversee and ensure compliance with all applicable Federal and State regulations relevant to the plan’s function. Develop and maintain tools and processes for proactive monitoring for all relevant quality and compliance performance metrics. Partner effectively with Medicaid Program Integrity operations to meet all LTSS requirements.
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.
Implements and monitors the business plan and oversees any implementations or business transitions impacting service operations. Develop and manage clinical operations focused on improving clinical and financial outcomes, member engagement, and satisfaction.
Develop and implement staffing models that are consistent, cost effective, and compliant with contractual obligations. Lead recruitment and operating model development to meet operational growth needs. Foster an environment that supports professional development, mobility, and operational excellence.
Develop, implement, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna Health Services strategies, policies, and programs.
Oversee 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. Develop, implement, and evaluate policies and procedures, which meet business needs (may cross multiple business functions). Direct enhancements to business processes, policies and infrastructure to improve operational efficiency (may cross multiple business functions). Collaborate and partner 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.
Develop and participate in presentations and consultations to existing and prospective customers. Participate in internal and external health industry development efforts.
Required Qualifications -Must be a resident of Florida
- Licensure: RN or Master level BH/SW Clinician in the state of Florida. Must be active and in good standing.
-Minimum 5 years of leadership experience managing/leading teams.
COVID Requirements
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.
Preferred Qualifications - Ability to develop business cases for new investments and work with finance to secure funding when additional staff are warranted.
- Ability to develop, evaluate and articulate current status, planning, and strategic initiatives via executive level presentations and able to speak professionally to Executive Level audience.
- Ability to successfully motivate, drive and lead colleagues in Manager, Supervisory and field level positions.
- Ability to interpret State contract to ensure Florida market is performing to contract expectations.
-Experience managing wider teams across different functions/departments.
- 5+ Years working in Medicaid LTSS.
-10+ Years of prior relevant experience.
Education Bachelor’s degree required for RN license and Master's degrees in either Behavioral Health, Social services or human services field required for BH license.
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.
Req ID 2156658BR
Clinical Licensure Required Licensed Clinical Social Worker (LCSW)
Job Category Aetna
Business Area Aetna
Job Type (Expected Hours Category) Full Time
Location - State/City FL - Tampa, FL - Work from home
Location code OF277
Street Address 8508 Benjamin Road Suite C
City Tampa
State FL
Zip Code 33634
Country United States
FLSA Exempt
Requisition Template Professional
Sourcing Requisition No
No. of Positions 1
Annual Min 100,000
Annual Max 221,000