Aetna Licensed Manager of Care Management - Roanoke/Bristol (VA MCD) in Bristol, Virginia

Req ID: 42181BR

POSITION SUMMARY

The Care Management Manager provides oversight and management of clinical team processes including the organization and development of high performing teams.

Fundamental components include, but are 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.

  • May be accountable for the day-to-day management of teams for appropriate implementation and adherence with established practices, policies and procedures if there is not supervisor position.

  • Works closely with functional area managers to ensure consistency in clinical interventions supporting our plan sponsors. Develop, initiate, monitor and communicate performance expectations.

  • May act as a single point of contact for the customer and the Account Team, which includes participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.

  • Participates 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.

    Qualification Requirements:

  • Minimum of 5-7 years in clinical area of expertise required.

  • Master's degree and active unrestricted State Licensure in applicable functional area (RN, LPC, and/or LCSW) required.

  • Background in Behavioral Health strongly preferred.

    Education:

    The minimum level of education required for candidates in this position is a Master's degree or equivalent experience.

    Licenses and Certifications:

    At least one of the following is required:

  • Registered Nurse (RN)

  • Licensed Clinical Social Worker (LCSW)

  • Licensed Professional Counselor (LPC)

    FUNCTIONAL EXPERIENCES

    Functional - Medical Management/Medical Management - Case Management/4-6 Years

    Functional - Medical Management/Medical Management - Administration/Management/1-3 Years

    TECHNOLOGY EXPERIENCES

    Technical - Desktop Tools/Microsoft Word/4-6 Years/End User

    Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User

    Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User

    ADDITIONAL JOB INFORMATION

    Additional experience and skills desired: Data analysis and monitoring of data. Reporting: ability to understand and create reports with productivity and service metrics; identify gaps. Computer skills, advanced in MS office suite, WORD, Excel; proficient in web and access databases. Dedicated advocate for plan and members. Presentation skills to both internal and external customers. Knowledge of community resources, provider networks. Familiarity with local health care delivery systems. Experience working with diverse teams and populations. Strong organizational skills with an attention to details.

    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 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.

Job Function: Health Care