Aetna Director, Clinical Health Services (RN or LCSW) in Detroit, Michigan

Req ID: 43197BR


As the Director you will 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. You will work with health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.

This is a unique program! You will be a liaison between the community and Aetna! This role will spend 2-4 weeks in the office in Michigan, then will work from home.

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 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.


8-10 years clinical leadership is needed Ability to synthesize program performance and clinical outcomes An RN with Behavioral Health experience, LMSW or LCSW is required Experience with community health and working with organizations that have integrated Behavioral Health and Clinical Health! Strong computer skills, including Power Point, Excel, Word, and Outlook! Needs to be extremely computer savvy, will work with the IT department for the state!


The highest level of education desired for candidates in this position is a Master's degree.


One of the following is required!

Nursing/Licensed Social Worker (LCSW) is desired

Nursing/Licensed Social Worker (LMSW) is desired

Nursing/Registered Nurse (RN) is desired

Nursing/Psychiatric and Mental Health Nurse is desired


Functional - Nursing/Mental Health/7-10 Years

Functional - Medical Management/Medical Management - Managed Care/Insurance Clinical Staff/7-10 Years

Functional - Management/Management - Administration/7-10 Years

Functional - Medical Management/Medical Management - Administration/Management/7-10 Years


Technical - Desktop Tools/Microsoft PowerPoint/7-10 Years/End User

Technical - Desktop Tools/Microsoft Project/4-6 Years/End User

Technical - Desktop Tools/Microsoft Word/7-10 Years/End User

Technical - Database/SQL Server/4-6 Years/End User


Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care