Director Case Management - Aetna Better Health of Oklahoma - RN
$99,420–$214,137 year
Hybrid · Oklahoma City, Oklahoma, United States
Job Summary
Director of Care Management leads the clinical team for Aetna Better Health of Oklahoma, directing the implementation and execution of the clinical operations plan, ensuring regulatory compliance, and delivering holistic, cost-effective care through care management and coordination services. The role emphasizes leading risk-based care delivery, aligning with risk stratification and contractual requirements, improving clinical and financial outcomes, engaging members, interfacing with regulatory bodies, and coordinating across claims, member services, quality, utilization management, and provider services. The position is fully remote with possible onsite meetings and requires residence within a one-hour commute to Oklahoma City; relocation may be available. The role also involves policy development, process improvement, data interpretation, and leadership of high-performing teams in a healthcare-operations context.
Required Qualifications
- Active and unrestricted Oklahoma RN license
- Minimum 10 years of clinical practice experience
- At least 5 years of management or clinical leadership (including oversight of case management leaders)
- 5 years of case management experience
- Managed care experience (Medicaid strongly preferred; commercial or Medicare acceptable)
- 3+ years of proficiency with MS Office Suite
- Nationally recognized case management certification (required or must be obtained within 90 days of employment)
- Master’s degree or equivalent experience (BSN preferred)
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