Aetna Business Project Program Manager - Crisis in Kenner, Louisiana

Req ID: 41746BR

POSITION SUMMARY

Oversees the crisis response system to ensure the health and well-being of Aetna Better Health of Louisiana members. Utilizes critical thinking and knowledge of crisis response program requirements, network and community resources, and Medicaid benefits to facilitate appropriate physical and behavioral healthcare and social services for members. Promotes effective utilization of available resources through collaboration with clinical and program staff, direct provider collaboration, and coordination of psychosocial wraparound community services. Promotes effective utilization of available resources, strives to achieve optimal member health, functioning and cost-effective healthcare outcomes.

Fundamental Components:

Supports the business by recommending appropriate actions, strategies and/or alternatives to meet business needs. Has responsibility for leading/managing all aspects of a project and or program such as planning, coordination, development, implementation including the financial implications while prioritizing work, resources and time. Ensures the business operations meets business objective(s) and that all deliverables and due dates are met. May oversees staff/teams or may manage the most complex projects or program through to implementation that impacts multiple processes, systems, functions and products.-Coordination duties related to complex patient populations and collaboration of services with community programs and providers including both mental health, substance use and medical services. Identification of crisis response service gaps and development of solutions. -May oversee transition of care for members discharging from inpatient settings and to/from the Aetna Medicaid program. Act as liaison and consults with community providers and care management providers, including State, Parish, and local community providers, providing information on physical and mental health and substance abuse programs, resources, and care program referrals. Interacts with clinical and seniors leaders within the health plan to discuss member specific health and service needs Monitors the administration of state specific programs to ensure compliance with required processes, identify staff training needs, and to collect program outcome data. Participates in the review of policies and procedures related to crisis response behavioral and physical health services. Coordinates with health plan staff (e.g. Member Services, Utilization Management, Care Management) to secure needed services for individual members. In conjunction with health plan staff (e.g. Utilization Management, Care Management) coordinate processes related to behavioral and physical health services, involving primary care physicians and related care team participants.

BACKGROUND/EXPERIENCE desired:

Strong general knowledge of health benefits business, clinical issues, trends, & medical management, as well as medical cost management, & quality improvement required

Demonstrated analytical skills & organization, with critical thinking & decision-making skills required

Project management skills are preferred

4+ years experience in the health care delivery system (clinical &/or industry levels) preferred

EDUCATION

The minimum level of education desired for candidates in this position is a Master's degree.

LICENSES AND CERTIFICATIONS

Clinical licensure is required - any of the several disciplines would be acceptable:

Mental Health/Licensed Clinical Social Worker is strongly preferred

Mental Health/Licensed Professional Counselor is strongly preferred

Mental Health/Marriage & Family Therapist is strongly preferred

Mental Health/Licensed Psychologist is strongly preferred

FUNCTIONAL EXPERIENCES

Functional - Clinical / Medical/General Management/1+ Years

Functional - Medical Management/Medical Management - Managed Care/Insurance Administration/1+ Years

Functional - Medical Management/Medical Management - Case Management/1+ Years

Functional - General Management/Process & quality improvement/1+ Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Word/1+ Years/End User

Technical - Desktop Tools/TE Microsoft Excel/1+Years/End User

Technical - Desktop Tools/Microsoft Outlook/1+ Years/End User

Technical - Desktop Tools/Microsoft SharePoint/1+ Years/End User

REQUIRED SKILLS

General Business/Applying Reasoned Judgment/MASTERY

General Business/Demonstrating Business and Industry Acumen/ADVANCED

Leadership/Driving a Culture of Compliance/FOUNDATION

DESIRED SKILLS

Finance/Profit and Quality Vigilance/ADVANCED

Leadership/Fostering a Global Perspective/FOUNDATION

Service/Creating a Differentiated Service Experience/ADVANCED

Telework Specifications:

Option for telework will be evaluated after a certain period of employment

Position requires a degree of field activity and travel statewide.

ADDITIONAL JOB INFORMATION

Opportunity to use acquired experience working with diverse population and clinical knowledge -Master's level clinician with LA state license required; relevant degree of study in behavioral health or human services is highly preferred (social work, psychology, marriage and family therapy, or counseling).

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: Management