Family Summary/Mission
Develop, implement, support, 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 are comprised of utilization management, quality management, network management and clinical coverage
and policies.
Position Summary/Mission
Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and
behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination
of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective
outcomes.
Fundamental Components & Physical Requirements include but are not limited to (* denotes essential functions)
member’s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member’s
benefit plan and available internal and external programs/services.- Applies clinical judgment to the incorporation of
strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and
resolution of member issues.
crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically
indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while
assessing benefits and/or member’s needs to ensure appropriate administration of benefits
meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve
optimal outcomes
behavior changes to achieve optimum level of health
healthy lifestyle choices.
comprehensive member needs.
and monitors established plans of care to meet the member’s goals
guidelines and company policies and procedures.
Pay Range
The typical pay range for this role is:
Minimum: 55,300
Maximum: 118,900
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
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
Education
Master’s degree 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.
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