Aetna Senior Director, Healthcare Services (56416BR) in Richmond, Virginia

Req ID: 56416BR

Aetna Better Health of Virginia is hiring a Senior Director, Healthcare Services.

Our Senior Director 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. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. Oversees 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. Coordinates business segment policies and procedures in support of financial, operational and service requirements. Integral part of the executive leadership team.

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/managed care/health care industry experience.

(*) Previous Case Management and Utilization Management and management experience in a managed care organization required

(*) Thorough knowledge of NCQA and/or HEDIS management.

(*) Multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes.

(*) Proven track record managing complex projects and or programs that resulted in cost savings.

(*) Experience managing large budgets.

(*) Demonstrated negotiation skills.

(*) Strong decision-making, analytical and organizational skills.

(*) Demonstrated verbal/written communication and computer skills.

(*) Ability to work in a fast paced environment.

(*) Proven ability to satisfy customer needs and develop alternatives to resolve issues.

(*) Ability to communicate effectively with all levels of management


The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience, Master's Degree Preferred


(*) Nursing/Board of Nursing (Any State) is desired

(*) Nursing/Registered Nurse (RN) is desired

(*) Nursing/Certified Long Term Care Nurse is desired


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

Functional - General Management/Multi-functional management: > 25 employees/7-10 Years

Functional - Nursing/Case Management/7-10 Years

Functional - Quality Management/Quality Management/4-6 Years

FunctionalExperience/FunctionalFocus/7-10 Years


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: Quality Management

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.