Executive Director, Integrated Care Management

Job DescriptionThe Executive Director, Integrated Care Management (ICM) will provide day to day leadership of a growing national Medicaid operation (set to exceed ~850 clinical and non-clinical staff across 14 markets in 2022). This Executive Director will facilitate the delivery of cost-effective, and high-quality care management programs and services for Aetna's ICM beneficiaries. This person will partner closely with the VP of Medicaid Care Management and collaborate across the enterprise to ensure that objectives are aligned, business strategies are delivered and financial, compliance and quality objectives are met.Drive strategic growth and enhancement of ICM models and capabilities:- Partner with the segment leadership and broader clinical services organization and participate in the development of short-term and long-term strategic plans required for Aetna's ongoing growth and success in the ICM / BH Medicaid segment.- Develop, translate, and execute the ICM clinical programs that effectively serves this population.- Create strategic, innovative, and tactical approaches to ICM that drive consistency, quality, and efficiency across MLTSS populations.- Inform model of care and workflow best practice in the development of new technology platforms and tools for CM across ICM programs.Deliver operational performance and compliance:- Meet all applicable clinical and operational goals for quality of care, cost of care and operating expense and ongoing efficiency improvements.- Deliver value to members by optimizing the member experience and maximizing member growth and retention.- Ensure that processes are aligned with the highest quality standards required by - Accreditation and Credentialing Organizations (for example, NCQA, etc.)- Oversee and ensure compliance with all applicable Federal and State regulations relevant to the plans function.- Develop and maintain tools and processes for proactive monitoring or all relevant quality and compliance performance metrics.- Partner effectively with Medicaid Program Integrity operations to meet all ICM requirements.Manage operations staff and develop workforce and organization:- Lead recruitment and operating model development to meet operational growth needs.- Develop and implement staffing models that are consistent, cost effective meeting all compliance obligations.- Collaborate with market CEO and state Medicaid agency's building a transparent and trusting relationship, meeting all state objectives.- Lead, develop, motivate, and manage a high performing team to meet organizational goals and objectives while effectively managing change.- Lead effectively in a matrixed environment with critical business functions provided by shared service divisions (Engagement Hubs, Network).- Lead a virtually integrated staff (including clinical and non-clinical members) within multiple geographic markets.- Foster an environment that supports professional development, mobility, and operational excellence.Required Qualifications- Ability to develop business cases for new programs/ investments and work with finance to secure funding.- Ability to develop, evaluate and articulate current status, planning, and strategic initiatives via executive level presentations and able to speak professionally to Executive Level audience.- Ability to understand synthesize data and address department productivity metric issues swiftly to hit targets/goals.- Understanding of reporting systems, interpret reports/data, and ability to report out status accurately and professionally for Executive Level audience.- Ability to successfully motivate, drive and lead colleagues in Manager and Sr Director level positions.- Ability to interpret state contracts and RFPs and ensure markets are performing to contract expectations.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications10-15 Years working in Medicaid CM Required15+ Years working in Medicaid CM PreferredEducationMasters Degree PreferredClinical Degree Required: RN, LCSW, or LCPCBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-10-04