Manager, Clinical Health Services - LTSS Service Decision Review

The Manager, Clinical Health Services - LTSS Service Decision Review is responsible for overseeing the clinical review of long-term services and supports (LTSS) for Aetna Better Health of Virginia. This role involves managing a team of nurses who conduct service decision reviews, ensuring compliance with state and federal regulations, and collaborating with care management teams. The position is remote but requires Virginia residency and licensure. Key duties include supervising clinical staff, reviewing complex cases, developing policies, and maintaining quality metrics. Requires an active RN license in Virginia, BSN preferred, and 5+ years of clinical experience, including 2+ years in LTSS or managed care.