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Supervisor, Clinical Outreach Team - Texas Star Kids

Primary Location: Dallas, TX
Additional Locations: TX-Dallas
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Description:
At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are 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 Texas STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.


This position will be working out of the 2777 Stemmons Freeway location in Dallas, TX

The UTR (Unable to Reach) Supervisor, develops, implements, supports, and promotes Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management, care management/service coordination and clinical coverage and policies. Responsible for the oversight of healthcare management staff including the organization and development of high performing teams. Works closely with functional area managers to ensure consistency in health related and psycho-social interventions supporting our members and is accountable for meeting the financial, operational and quality objectives of the unit. The UTR team supports the service coordination function by utilizing all data available to Aetna as well as community contacts to engage with members who have been difficult to reach. This engagement ensures members receive all services and supports they need to maintain health. The UTR team will support all service coordination pods and may cross cover for other service coordination non-clinical functions as needed.


Fundamental Components:
Oversee the implementation of healthcare management services for
assigned functional area. Accountable for maintaining policies & procedures
in accordance with applicable regulatory and accreditation standards and
implementing them at the employee level (e.g. NCQA, URAC, state and
federal standards and mandates as applicable). 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. Manage 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. 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. Assess 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
demonstrate the ability to serve as a model change agent and lead change
efforts. Collaborate with licensed staff from other areas that assist with
oversight of clinical staff and activities of licensed personnel. Serve as a
content model expert and mentor to the team regarding practice standards,
quality of interventions, problem resolution and critical thinking.

Background Experience:
  • 3+ years of experience in a physical or behavioral healthcare setting
  • 1+ years management experience
  • 1+ years call center experience in a healthcare setting is preferred
  • Pediatric/Adolescent experience preferred
  • 3+ years of experience in managed care
  • Knowledge of the regulations, standards, and policies which relate to medical management
  • Minimum Bachelor’s degree in health or human services (e.g. Social Work, Psychology, Nursing, Mental Health, Counseling, Behavioral Sciences, Sociology, Gerontology or related field required. A Master’s degree in one of the above noted fields or MPH, MHA is preferred.


Clinical Licensure:
N/A

Potential Telework Position:
No

Percent of Travel Required:
0 - 10%

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

Benefit Eligibility:
Benefit eligibility may vary by 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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