Skip to main content

Clinical Team Lead - Commercial Precert

Primary Location: Blue Bell, PA
Additional Locations: GA-Atlanta, MO-Crestwood, MO-Hazelwood, MO-St Louis, NC-Cary, NC-Charlotte, NC-High Point, OH-New Albany, OH-Richfield, PA-Bethlehem, PA-Blue Bell, PA-Harrisburg, PA-King of Prussia, TX-Arlington, TX-Dallas, TX-Sugar Land, VA-Bristol, VA-Charlottesville
The Team Lead is accountable to leadership to support the day to day operations of the team. This position has no supervisory oversight of staff, but requires a solid understanding of the workflows, policies and procedures to ensure the team is producing at a successful level. The Team Lead supports the onboarding of new staff as well as quality monitoring and assignment triage. The Team Lead is a single point and first line of contact for staff for clinical issues. They may lead projects as assigned. The Team Lead provides ongoing communication and updates to leadership and contributes and participates in team meetings. The role requires promoting cooperation and team-building between all department members.

Fundamental Components:
Serve as a resource to team members(*) Serve as a content model expert and mentor to the team regarding practice standard, quality of interventions, problem resolution and critical thinking Ensure adherence to plan sponsor performance targets(*) Develop, implement and support program policies and procedures(*) Utilize critical thinking skills to raise the level of team�s performance Mentor the team; monitoring and providing feedback regarding performance relative to best practices Act as a role model for the Aetna values, particularly regarding company policies on confidentiality(*) Communicate effectively with a variety of audiences Well organized and able to prioritize tasks Support a positive work environment that promotes the concept of teamwork Support to Supervisors as directed May have responsibility for their own case load work Respond to issues and inquiries as needed Sedentary work involving periods of sitting, talking, hearing, work requires visual acuity to perform close inspection of hand written and computer generated documents as well as a PC monitor.

Background Experience:
3+ years of clinical experience required
Registered Nurse
Managed Care experience preferred
2+ years of Utilization Management experience required
2+ years of Precert experience preferred
Excellent critical thinking skills
Computer literacy (Microsoft Outlook, Excel and Word)
Strong customer service skills

Additional Job Information:
The Team Lead will be responsible for being the first line for operational questions from staff, organize and conduct audits and training as needed, assist in trouble shooting issues, and will work closely with Supervisors.

Required Skills:
Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality, Benefits Management - Understanding Clinical Impacts

Desired Skills:
Leadership - Collaborating for Results, Service - Working Across Boundaries

Functional Skills:
Clinical / Medical - Precertification, Nursing - Clinical coverage and policies, Nursing - Legal and benefit interpretation, Nursing - Medical-Surgical Care

Technology Experience:
Aetna Application - Aetna Total clinical View

Nursing - Registered Nurse

Potential Telework Position:

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this 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.

Click To Review Our Benefits (PDF)


Jobs for you

Recently Viewed Jobs

You do not have any recently viewed jobs

Your Saved Jobs

You do not have any saved jobs

Sign up for Job Alerts

Join our Talent Community

At Aetna, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna.

Join Our Talent Community

Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna.