Aetna Clinical Health Services Supervisor in Harrisburg, Pennsylvania

Req ID: 44528BR

Work at Home is possible, but not guaranteed. Candidates should be commutable to central PA for travel as needed. May be required to be "on call" once every two months on the weekend.

POSITION SUMMARY

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.

FUNDAMENTAL 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

  • 2 years + Experience with Utilization Management or Concurrent Review is required.

  • Prior experience in Management or Team Leader is preferred.

  • RN License is required

  • Experience in collaborating with others to achieve desired results is required

  • Strong written and verbal communication skills are required

LICENSES AND CERTIFICATIONS

Registered Nurse (RN)

EDUCATION

The minimum level of experience for this role is an Associate's degree or equivalent experience.

ADDITIONAL CANDIDATE INFORMATION:

Utilization Management (Precertification) Review preferred. Required Skills-Supporting Medical Practice, Understanding Clinical Impacts, and Leveraging Technology Desired Skills-Turning Data into Information, Collaborating for Results, Providing Solutions to Constituent

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