TX STAR+PLUS RN Concurrent Review SupervisorPrimary Location: Dallas, TX
Additional Locations: TX-Dallas Apply
68289Fundamental 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. Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when needed. Accountable for maintaining compliance with policies and procedures and implements them at the employee level. Background Experience: 3+ years in clinical area of expertise required. (Certain functional areas may require additional clinical experience such as for BH triage and referral Supervision decisions must have 5 years post master’s degree clinical experience required.)
1+ year Supervisory experience required
Registered Nurse (BSN preferred) ; or Master's degree in behavioral health field AND active unrestricted State Licensure in applicable functional area. (e.g. RN, LPC, LCSW).
Previous concurrent review experience preferred.
Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, MS Office Suite applications, including Word and Excel, and web-based applications.
Ability to work with people in such a manner as to build high morale and group commitment to goals and objectives.
Ability to evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes.
Ability to communicate effectively with Providers, Members, Staff and other Leaders both in oral and written formats (e.g., may provide support to the sales staff & network staff via onsite customer visits and/or presentations). Additional Job Information: Typical office working environment with productivity and quality expectations. Work requires the ability to perform close inspection of handwritten and computer-generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. This position is office based and will require direct supervision of office-based staff.
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+PLUS, STAR/CHIP, and STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals. Required Skills: Benefits Management - Interacting with Medical Professionals, Benefits Management - Supporting Medical Practice, Benefits Management - Understanding Clinical Impacts Desired Skills: Benefits Management - Maximizing Healthcare Quality, General Business - Maximizing Work Practices, Leadership - Developing and Executing Strategy Functional Skills: Clinical / Medical - Precertification, Nursing - Concurrent Review/discharge planning, Nursing - Critical Care, Nursing - Home Health Care Ambulatory Nursing, Nursing - Medical-Surgical Care, Nursing - Mental Health Technology Experience: Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel Education: Nursing - Registered Nurse (RN) 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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