At Aetna, we’re pioneering a total approach to health and wellness, focusing on the whole person - body, mind, and spirit. Our more than 4,000 nurses are central to turning our member’s health ambitions, big and small, into achievements. Your role will include helping members stay well, manage health conditions, and access the right care at the right time. As you do this, we’ll support you in achieving more in your life and your work.
What makes a successful nurse? Here are the traits we are looking for:
- Problem Solver
- Results Driven
- Technology Savvy
- Detail Oriented
- Good Listener
- Open Minded
- Team Player
Paid Time Off & Disability
Supervisor, Clinical Health Services (RN)Primary Location: New York, New York
Additional Locations: NY-New York Apply
The Supervisor is responsible for management of medical services staff including the organization and development of high performing teams. Works closely with managers (re: Case/Disease Management) ensuring consistency in care management interventions across membership. Facilitates effective interfaces among team members, as well as across teams, providers and Aetna departments. Responsible for the day-to-day implementation of Aetna's medical management services policies and procedures. Accountable for meeting the financial, operational and quality objectives of the unit.
- Oversees the implementation of Aetna medical management services including but not limited to Inpatient Care Coordination/Discharge Planning/Case Management/Disease Management/Precertification and monitors daily performance to ensure business goals are met and compliance with Aetna policies and procedures is maintained
- Implements clinical policies & procedures in accordance with NCQA, URAC, state and federal standards and mandates
- 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 between National Care Management Program Design, Specialty Services and other National Care Management programs to ensure successful implementation of continuum of care programs
- May develop/assist in development and/review new training content
- May collaborate/deliver inter and intra-departmental training sessions
- 4+ years of case management experience is required
- 1+ years of supervisory / management experience is required
- Ability to communicate effectively with Providers, Members, and Staff & Upper Management in both an oral and written format.e.g., may provide support to the sales staff & network staff via onsite customer visits and/or presentations is required
- Ability to evaluate and interpret clinical and utilization data, identify areas of improvement, and focus on interventions to improve outcomes is required
- Ability to work with people in such a manner as to build high morale and group commitment to goals and objectives is required
- MLTC (Managed Long Term Care) experience is preferred
- Bilingual in Mandarin Chinese, Russian, Spanish, Serbian or Bengali strongly preferred
- Computer literacy and experience familiarity with Excel, MS Word, and web-based applications desired.
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is required
Functional - Nursing/Case Management/4+ Years
Functional - Management/Management - Health Care Delivery/1+ Years
Technical - Desktop Tools/Microsoft Outlook/4+ Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/1+ Years/End User
4 days work from home and 1 day in office after 3-6 month orientation and demonstrated proficiency
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidates'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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