Aetna Director, Clinical Health Services - Case Management in Downers Grove, Illinois

Req ID: 54131BR


Oversees the implementation and on-going execution of the strategic and operational business plan for the business segment's clinical operations including Case Management and Utilization Management, inbound/outbound call queue, implementation, and/or plan sponsor operations. Coordinates business segment policies and procedures in support of financial, operational and service requirements.

Fundamental Components but not limited to the following:

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

Quickly and effectively learns and adapts leadership style and strategic direction to the changing demands of the internal and external environment

Communicates in a candid, transparent and persuasive manner, seeking others input and adjusting approach based on audience and the need

Builds an optimistic environment where teams and individuals trust each other and work together to meet Aetnas goals and create customer and shareholder value

Arrives at appropriate recommendations and solutions in a manner that effectively balances the management of risk with the maximization of opportunities

Demonstrates urgency and holds self and others accountable for achieving high standards of performance and service

Seeks out, introduces and applies innovative ideas to Aetna with input from customers and active involvement in industry


8+ years clinical leadership experience, managed care preference

8+ years experience Leading & Managing team of up 50+ to field and onsite

3+ years of experience with Medicare Advantage, Duals and Medicaid in these areas

Ability to synthesize program performance and clinical outcomes

Cross functional experience with Care Management and Utilization Management


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


Nursing/Registered Nurse (RN)

Licensed Social Worker (LSW)

Active unrestricted State Licensure in applicable functional area. (eg RN, LPC, LCSW)


Functional - Management/Management - Multifunctional management: >40- 50 employees/4-6 Years

Functional - Management/Management - Health Care Delivery/1-3 Years

Functional - Medical Management/Medical Management - Case Management/1-3 Years


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

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

Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User

Technical - Desktop Tools/Microsoft Visio/1-3 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 candidates'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

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.