Utilization Management SupervisorPrimary Location: Downers Grove, IL
Additional Locations: IL-Downers Grove Apply
65350Fundamental 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 RN experience or 5 years post master’s degree clinical Behavioral health experience; Required
1+ years of Managed Care or Utilization Management experience; Required
1+ years of Leadership Experience; Preferred
Active unrestricted State Licensure in applicable functional area; Required (eg RN, LPC, LCSW)
Registered Nurse with BSN; Preferred
Master's degree in behavioral health field required if not an RN
Computer literacy and experience familiarity with Microsoft Excel, Word, and web-based applications desired.
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) Required Skills: Finance - Delivering Profit and Performance, General Business - Applying Reasoned Judgment, General Business - Communicating for Impact Desired Skills: General Business - Applying Reasoned Judgment, General Business - Maximizing Work Practices, Leadership - Anticipating and Innovating, Leadership - Creating Accountability Functional Skills: Clinical / Medical - Concurrent review / discharge planning, Clinical / Medical - General Management, Clinical / Medical - Management: < 25 employees Technology Experience: Desktop Tool - Microsoft Conference Server, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint Education: Nursing - Registered Nurse Potential Telework Position: Yes Percent of Travel Required: 10 - 25% 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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