We are seeking an experienced and skilled Aetna Case Manager to join our team at Workwarp. As a Case Manager, you will play a crucial role in managing federal medical insurance and long-term care lines of business. This is a remote opportunity with a competitive salary and immediate start date available.
The successful candidate will assist the Chief Operating Officer (COO) in the successful development and execution of the program, including financial management, interface, collaboration, and cooperation with corporate office functional leaders and unified shared services business divisions. The ideal candidate will have a deep understanding of case management systems and processes, value-based contracts, and compliance programs.
Key Responsibilities:
- Manage the federal medical insurance and long-term care lines of business
- Provide timely, accurate, and complete reports on the operational status of the program
- Develop policies and procedures for assigned areas and ensure that other affected areas review new and changed policies
- Assist the COO in collaborative efforts related to the development, communication, and execution of effective growth strategies and processes
- Lead the implementation of new projects, services, and preparation of proposed and award proposals
- Collaborate with the program management team and others to develop and implement action plans for the operational infrastructure of systems, processes, and staff
- Participate in the development and execution of marketing plans for the program and ensure compliance with program guidelines
- Assist in defining marketing and advertising strategies within state guidelines
- Ensure compliance with regulations, rules, and guidelines, company policies, and procedures for every assigned area
Requirements:
- Residence in Ohio (relocation package available for qualified candidates)
- Ability to work in a hybrid model (in-office Tuesday, Wednesday, Thursday)
- Proven experience in government programs like Medicaid, Medicare, or Dual Eligibles, including government contracts, legal, and compliance background
- Deep understanding of case management systems and processes, value-based contracts, and compliance programs
- Knowledge of credentialing, provider relations, network development, and supplier information
- High awareness of the marketing of Medicaid, communications to members and providers, community programs, and social determinants of health (SDOH)
- Ability to work collaboratively across multiple teams, prioritize requests, integrate information, and draw meaningful conclusions
- Proven leadership experience with relevant initiatives: business process improvement, project management, financial strategic planning, and risk management
If you are a motivated and experienced professional looking for a new challenge, we encourage you to apply for this exciting opportunity. Please submit your application today and let's build the future together!
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