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Manager, Delegation Oversight Unit

Primary Location: San Diego, CA
Additional Locations: CA-San Diego
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Description:

The Manager of the Delegation Oversight Unit develops, implements, supports and promotes clinical strategies, policies and programs that drive the delivery of quality healthcare to our members. The Manager, Delegation Oversight Unit is responsible for the day-to-day oversight and management of team processes including the organization and development of high performing teams. The primary responsibility centers around ensuring oversight and deliverables of our independent practice associations (IPA's) and leading the team that supports the work.



Fundamental Components:

Fundamental Components include, but not limited to:

  • Reinforces clinical philosophy, programs, policies and procedures. Communicates strategic plan and specific tactics to meet plan. Ensures implementation of tactics to meet strategic direction for cost and quality outcomes.
  • Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results. Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes. Accountable for meeting the financial, operational and quality objectives of the unit. Accountable for the day-to-day management of teams for appropriate implementation and adherence with established practices, policies and procedures.
  • Works closely with functional area managers to ensure consistency in clinical interventions supporting our plan. Develop, initiate, monitor and communicate performance expectations.
  • 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.
  • Consistently demonstrates the ability to serve as a model change agent and lead change efforts.
  • Accountable for maintaining compliance with policies and procedures and implements them at the employee level. Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.


Background Experience:


5+ years Clinical Practice experience; Required (Acute Care preferred)

3+ years utilization management experience is; Required

1+ years leadership and supervisory experience is; Required

Delegation Oversight Experience; Preferred

An active and unrestricted Registered Nurse (RN) Licensure within the State of California

Bachelor's in Nursing required and Master's degree in healthcare or related field preferred



Additional Job Information:
  • This individual will lead a newly formed Delegation Oversight Unit which includes providing oversight of our IPA's and ensuring respective deliverables are met.
  • Experience working in a regulatory environment is preferred
  • Experience with IPA's is preferred
  • Some experience with concurrent review and prior authorization is preferred
  • Medi-Cal experience is a plus!
  • Computer literacy and advanced proficiency with Microsoft Excel, Word, and web-based applications and access databases is required


    • Ability to understand and create reports with productivity and service metrics; identify gaps



    • Policy and procedure experience with a demonstrated ability to operationalize policies to desktops



    • Dedicated advocate for plan and members



    • Demonstrated ability to deliver presentations to both internal and external customers



    • Knowledge of community resources and provider networks



    • Presentation skills to both internal and external customers



    • Familiarity with local health care delivery systems



    • Experience working with diverse teams and populations



    • Strong communication and organizational skills with an attention to detail.



    • Ability to evaluate and interpret data, to identify areas of improvement, and focus on interventions to improve outcomes




Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Education:
Nursing - Registered Nurse

Potential Telework Position:
No

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.

Click To Review Our Benefits (PDF)

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