Aetna VP Medical Management (Director Clinical Health Services) in San Diego, California

Req ID: 50084BR


Aetna Better Health of California (An Aetna Medicaid Plan) is looking for a VP of Medical Management (Director of Clinical Health Services). The VP of Medical Management will oversee 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. The VP will also coordinate the business segment policies and procedures in support of financial, operational and service requirements. Offices in San Diego and Sacramento; position will require in-state travel and travel to corporate Medicaid offices in Phoenix, AZ.

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).

Implement and monitor business plan and oversees any implementations or business transitions impacting service operations.

Collaborate and partner 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.

Background / Experience:

Eight to Ten years of clinical leadership required. Seven to Ten years of managed care experience desired, and at least three years of experience required in California delegated model either with a health plan or IPA interfacing with external Medical Management partner(s)

Master's degree in behavioral health field; or Registered Nurse (Masters preferred): and-Active unrestricted State Licensure in applicable functional area. (eg RN, LPC, LCSW)

Ability to synthesize program performance and clinical outcomes.

Demonstrated management experience selecting, motivating and leading teams; mentoring and coaching staff.

Exceptional communication skills, verbal, written and presentation.

Proficiency with MS Office Suite, applications.


The level of education desired for candidates in this position is a Bachelor's degree or equivalent experience. Master's Degree preferred but not required.

License and Certifications:

Nursing/Registered Nurse (RN) and / or Mental Health / Licensed Clinical Social Worker.

Functional Experiences:

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

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

Functional - Medical Management/Medical Management - Concurrent Review/7-10 Years

Functional - Clinical / Medical/Management: < 25 employees/7-10 Years

Functional - Clinical / Medical/General Management/7-10 Years

Technology Experiences:

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

Technical - Desktop Tools/TE Microsoft Excel/7-10 Years/End User

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

Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User


Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of California is looking for people like you who value excellence, integrity, caring and innovation. As an employee, youll join a team dedicated to improving the lives of the most vulnerable in our population. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of California, and we will support you all the way.

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