At Aetna Better Health of Texas, we are committed to helping people on their
path to better health. By taking a total and connected approach to health, we
guide and support our members so they can get more out of life, every day. We
are looking for people like you who value excellence, integrity, caring and
innovation. As an employee, you’ll join a team dedicated to improving the
lives of Texas STAR Kids members. We value diversity and are dedicated to
helping you achieve your career goals.
The STAR Kids Program Director oversees Service Coordination for the STAR Kids
implementation and on-going execution of the strategic and operational
business plan. Coordinates policies and procedures in support of financial,
operational and service requirements. This position is office based in Dallas.
This position will require travel 10-20% of the time, per business needs.
Required use of a personal vehicle for when traveling in the service areas;
must have active and valid TX driver’s license, reliable transportation and
vehicle insurance. Business mileage is eligible for reimbursement, in
accordance with travel policy guidelines. 71060
* Developing and implementing clinical programs and policies.
* Enhancing relationships with providers, facilities, plan sponsors, regulatory agencies.
* Key business partner in network development, product design, strategic planning and sales support.
* 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 to ensure compliance with regulatory requirements 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.
* Implements and monitors business plan and oversees any implementations or business transitions affecting service operations.
* 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.
* Registered Nurse (Masters preferred) OR Master’s degree in behavioral health field AND Active unrestricted State Licensure in applicable functional area (eg., RN, LCSW, LMSW, LPC, ), is required .
* 8 or more years clinical leadership or managed care leadership experience is required.
* Experience working with Medicaid members is required; experience working with special needs children is preferred.
* Previous MCO experience is preferred.
* Demonstrated experienced leading and managing operational results using goal setting and performance metrics.
* Ability to synthesize program performance and clinical outcomes.
* Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
* Ability to work with people in such a manner as to build high morale and group commitment to goals and objectives.
* Ability to evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes.Ability to communicate effectively with Providers, Members, Staff and other Leaders both in oral and written formats (e.g., may provide support to the sales staff & network staff via onsite customer visits and/or presentations).
* Exceptional communication skills, verbal, written and presentation.
Potential Telework Position:
Percent of Travel Required:
10 – 25%
Aetna is an Equal Opportunity, Affirmative Action Employer
Benefit eligibility may vary by position.
Candidate Privacy Information:
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.