Manager, Clinical Health Services - Aetna Medicaid UM Letters Team

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

The Manager, Clinical Health Services leads a team within the Medicaid Centralized Letters organization, overseeing the creation, auditing, and distribution of authorization determination and member notification letters for Medicaid plans. This role manages a team of approximately 20 colleagues and partners closely with peer leaders across the centralized letters function to ensure compliance with state contractual requirements, regulatory standards, and turnaround time expectations.

The manager drives operational excellence, develops high-performing teams, collaborates with internal and external stakeholders, and supports strategic initiatives that enhance quality, consistency, and efficiency across the organization.

This is a fully remote position. Eligible candidates may live anywhere in the contiguous United States.

• Lead the day-to-day operations of a Medicaid Centralized Letters team, ensuring accurate and timely delivery of member notification and authorization determination communications.
• Ensure compliance with state contractual requirements, regulatory standards, accreditation requirements, and established turnaround times.
• Monitor operational performance and analyze data to identify opportunities for process improvement, quality enhancement, and increased efficiency.
• Partner with internal business partners, peer leaders, and external vendors to support effective execution of member communication processes.
• Implement and monitor clinical policies, procedures, and operational practices in accordance with applicable state, federal, and accreditation requirements.
• Support continuous improvement efforts by identifying and implementing best practices that improve service delivery and operational performance.

• Active, current, and unrestricted RN license in the state of residence.
• 5 years relevant work experience.
• 2+ years of managed care experience.
• Demonstrated leadership experience in a Team Lead, Supervisor, or higher-level leadership role.
• Proficiency with Microsoft Office applications, including Outlook, Word, Excel, and PowerPoint.
• Ability to work core business hours, Monday through Friday, 8:00 AM to 5:00 PM, with flexibility to work occasional weekends as business needs require.
• Ability to work beyond regularly scheduled hours as needed to meet business objectives.
• Ability to travel up to 5% for meetings, audits, and implementation activities.

• Experience with Utilization Management and prior authorization processes.
• Experience working with state contractual requirements, regulatory guidelines, and member notification compliance within a managed care environment.
• Experience with NCQA standards and accreditation requirements.
• Experience partnering with external vendors to support operational objectives.
• Ability to work independently in a remote environment while effectively collaborating with virtual teams.
• Education Master’s degree or equivalent clinical experience*, BSN preferred*
• Equivalent years of experience defined by CVS Policy:
  If candidate has associate’s degree, additional 4 years of experience is needed. If candidate has bachelor’s degree, an additional 2 years of experience is required.

Anticipated Weekly Hours
40

Time Type Full time

Pay Range The typical pay range…