Clinical Health Service SupervisorPrimary Location: New Albany, Ohio
Additional Locations: OH-New Albany Apply
Standard business hours with flexibility required. Occasional weekend on call coverage is required.
The A1A Supervisor of Clinical Services, is responsible for oversight of the clinical team supporting the Aetna One Advocate Program. The Supervisor is responsible for leading a team of 15-20 clinical resources and non-clinical resources and development of a best in class, high performing team and is accountable for meeting the financial, operational and quality objectives of the unit. The Supervisor works closely with the A1A Manager as well as the other functional area Managers to ensure consistency in clinical interventions, implementation of clinical policy and processes to ensure the delivery of high quality clinical programs and services.
61619Fundamental 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: -An active and good standing RN license is required
-3+ years of clinical experience required
-Prior leadership experience is highly preferred
-Prior case management experience is preferred
-Computer literacy and experience familiarity with Microsoft Excel, Word, and web-based applications preferred
-Ability to work with people in such a manner as to build high morale and group commitment to goals and objectives required
-Ability to evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes required
-Ability to communicate effectively with Providers, Members, Staff and other Leaders both in oral and written formats required Additional Job Information: Demonstrates highly developed communication and people skills. Ability to engage and interact easily with diverse group of individuals. Strong listener, empathetic and supporting. •Ability to prioritize and multitask in fast paced, deadline driven environment. •Ability to adapt to constantly changing demands and environment. •Strong public speaking and presentation skills. •Demonstrates a commitment to service; accountable for actions and issues resolution, responsive to customer needs. •Ability to work with people in such a manner as to build high morale and group commitment. •Demonstrates strong problem solving skills and ability to work independently. •Ability to evaluate and interpret data, identify areas for improvement and focus on interventions to improve outcomes. •Requires proficiency with computer skills including keyboarding, navigating multiple systems. •Proficiency in use of Microsoft Outlook and Office. •Must be able to work in office setting with extended periods of time sitting, talking on telephone and typing on computer. Functional Skills: Nursing - Case Management, Nursing - Concurrent Review/discharge planning Technology Experience: Aetna Application - Aetna Strategic Desktop Reporting, Aetna Application - Aetna Total clinical View, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word Education: Nursing - Certified Case Manager (CCM), Nursing - Registered Nurse 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. 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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