The Supervisor is responsible for oversight of healthcare management staff including the organization and development of high performing teams. Works closely with functional area managers to ensure consistency in clinical interventions supporting our members. Accountable for meeting the financial, operational and quality objectives of the unit.
64897 Fundamental Components:
•Oversees the implementation of healthcare management services for assigned functional area
•Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g. NCQA, URAC, state and federal standards and mandates as applicable).
•Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking.
•Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care.
•May act as a liaison with other key business areas.
•May develop/assist in development and/review new training content.
•May collaborate/deliver inter and intra-departmental training sessions.
•Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
•Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating and documenting of care.
•Develop, initiate, monitor and communicate performance expectations.
•Ensures the team's understanding and use of information system capability and functionality.
•May have responsibility for their own case load work.
•May act as a single point of contact for the customer and the Account Team including: participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.
•Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills.
•Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams.
•Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance.
•Consistently demonstrates the ability to serve as an model change agent and lead change efforts.
•Accountable for maintaining compliance with policies and procedures and implements them at the employee level. Background Experience:
• Active, unrestricted Registered Nurse (RN) licensure for the State of WV (BSN preferred) is required.
+ years experience in clinical area of expertise required. • 2+ years of supervisory experience is required.
•1+ year of Utilization Management/Prior Authorization experience is preferred.
•Managed Care experience is preferred. Additional Job Information:
Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of West Virginia is 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 our members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of West Virginia, and we will support you all the way. Required Skills:
Benefits Management - Maximizing Healthcare Quality, Benefits Management - Understanding Clinical Impacts, Leadership - Engaging and Developing People Desired Skills:
Benefits Management - Interacting with Medical Professionals, Finance - Managing Aetnas Risk, Leadership - Collaborating for Results Functional Skills:
Clinical / Medical - Clinical claim review & coding, Clinical / Medical - Concurrent review / discharge planning, Clinical / Medical - Direct patient care (hospital, private practice) Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel Education:
Mental Health - Licensed Clinical Social Worker, Mental Health - Licensed Professional Counselor, Nursing - Registered Nurse (RN) Potential Telework Position:
Yes 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.
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