Manager, Clinical Health Services – Aetna Medicaid UM Letters Team

CVS Health

. Lead the day-to-day operations of a Medicaid Centralized Letters team .

Posted 10/8/2026full-timeRemote • United StatesMid-LevelSenior💰 $78,331 - $168,714 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicaid operations, ensuring compliance with state and federal regulations while leading a high-performing team. Proficient in Utilization Management and member notification processes, with a focus on continuous improvement and operational efficiency.

Highest-signal resume keywords

Active RN LicenseManaged Care ExperienceLeadership ExperienceUtilization ManagementNCQA Standards

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Operational Performance MonitoringData AnalysisProcess ImprovementQuality EnhancementClinical Policy Implementation

Soft Skills

Team DevelopmentCollaborationCommunication

Tools & Technologies

Microsoft OfficeOutlookWordExcelPowerPoint

Industry Keywords

MedicaidRegulatory ComplianceAccreditation RequirementsMember NotificationContractual Requirements

About the role

Key responsibilities & impact

Lead the day-to-day operations of a Medicaid Centralized Letters team
Ensure 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
Manage a team of approximately 20 colleagues
Develop high-performing teams and support strategic initiatives across the centralized letters organization

Requirements

What you’ll need

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
Master’s degree or equivalent clinical experience
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

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to base pay
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being