Aetna Registered Nurse (RN) - Prior Authorizations Department Supervisor (VA MCD) in Richmond, Virginia

Req ID: 44003BR

POSITION SUMMARY

The Prior Authorizations Department 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 include, but are not limited to:

Oversee 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.

  • Protect the confidentiality of member information and adheres to company policies regarding confidentiality.

  • Manage 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.

  • Ensure 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.

  • Assess 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.

    Qualification Requirements:

  • 3 to 5 years in clinical area of expertise

  • Ability to communicate effectively with Providers, Members, Staff and other Leaders both in oral and written formats.

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

  • Ability to work with people in such a manner as to build high morale and group commitment to goals and objective.

    Education:

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

    Licenses and Certifications:

  • Registered Nurse is required

    FUNCTIONAL EXPERIENCES

    Functional - Clinical / Medical/Management: < 25 employees/1-3 Years

    Functional - Medical Management/Medical Management - Direct patient care/4-6 Years

    Functional - Clinical / Medical/Precertification/4-6 Years

    TECHNOLOGY EXPERIENCES

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

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

    Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User

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

    ADDITIONAL JOB INFORMATION

    Education and Certification Requirements: Registered Nurse (BSN is preferred): and Active unrestricted State Licensure in applicable functional area. (eg RN) -1-3 years of UM, prior authorizations experience is preferred. MCO experience is highly desired. Minimum of 1-3 years supervisory or management experience. Reporting: ability to understand and create reports with productivity and service metrics; identify gaps Computer literacy and advanced proficiency and keyboard navigation skills with Microsoft Excel, Word, and web-based applications and access databases is required Knowledge of community resources and provider networks Experience working with diverse teams and populations Ability to multitask, prioritize and effectively adapt to a fast paced changing environment

    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