Supervisor Clinical HiTech/Hospitality VerticalPrimary Location: San Antonio, TX
Additional Locations: TX-San Antonio Apply
The Supervisor is responsible for oversight of healthcare management staff including the organization and development of high performing teams. Works closely with functional area managers to ensure consistency in clinical interventions supporting our members. Accountable for meeting the financial, operational and quality objectives of the unit. This supervisor will be responsible for building/implementing the care management team for our HiTech/Hospitality industry vertical clinical team.
63861Fundamental 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: RN licensure required
3+ years clinical experience required
Supervisory experience preferred
Case management experience preferred
Utilization management experience preferred
Ability to work with people in such a manner as to build high morale and group commitment to goals and objectives
Computer literacy and experience familiarity with Microsoft Excel, Word, and web-based applications desired
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 Additional Job Information: oversight of a new and growing industry specific care management team that will focus on members in the technology and hospitality Industries only. This is known as our HiTech/Hospitality Vertical. The team will have some clinical resources sitting with the health concierge team in Fresno with the base team sitting in San Antonio Texas. The position will take focus, strong organizational skills, ability to implement new customers and existing customers as well as work with the product teams to build new solutions which are already underway through 2020 and 2021. These will enhance the model and offer value based differentiation in the marketplace. Must have very good communication skills and the ability to present to clients if needed.
Required Skills: Benefits Management - Interacting with Medical Professionals, Leadership - Collaborating for Results, Leadership - Creating a World Class Workforce Desired Skills: Benefits Management - Understanding Clinical Impacts, Leadership - Creating Accountability, Leadership - Driving a Culture of Compliance Functional Skills: Communication - Communication Delivery - Public Speaking, General Management - Multi-functional management: < 25 employees, Leadership - Lead a business in different geographies or multiple markets, Leadership - Lead a complex or multifunctional organization Technology Experience: Aetna Application - Aetna Total clinical View, Aetna Application - TE Aetna Strategic Desktop, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word Education: Nursing - Certified Case Manager (CCM), 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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