Manager, Clinical Health Services - Aetna Oncology Care Model Team - RN

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Position Summary:

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.

Job functions may include the following:

• 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.

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