Aetna Clinical Operations Manager in Sunrise, Florida
Req ID: 45774BR
The Clinical Operations Manager is responsible for business, clinical and operational performance and oversees the direct supervision, guidance and job performance of a group of Care Manager Supervisors, who manage the care management staff serving high risk commercial and Medicare Advantage members in a new innovative community based program. The Clinical Operations Manager reports directly to the Executive Director of Operations, and provides leadership and oversight of productivity and quality performance to optimize member well being, clinical and cost effective outcomes.
Additional Job Responsibilities:
Leads and directly manages a team of Care Management Supervisors, upholding all program objectives to optimize business, clinical and operational performance and outcomes
Provides clinical expertise and business direction to operationalize protocols and drive the effective execution of care management services
Prepares, analyzes and applies pertinent data, metrics and reports to monitor and enhance quality, productivity, and assure adherence to policy and procedures
Coaches and guides clinical supervisors in order to build individual and team competencies and performance
Knowledgeably manages a virtual, work at home workforce
Applies critical thinking and deliberately identifies opportunity for process improvements and corrective actions
Participates in the clinical leadership team to promote continuous quality improvement and actively contributes to care management best practice standards and strategies
Deliberately facilitates team building and inter-disciplinary collaboration
Adheres to care management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
Maintain a comprehensive working knowledge of managed care, benefits and services for target population to maximize member and program outcomes
Understanding of a local, community based, care management model, delivered both in person, and telephonically
Minimum of 2 years' clinical operations management experience required; proven leadership/team building skills
5 years' clinical experience required
Ability to travel within a designated geographic area
Ability to work flex hours
Excellent written & verbal communication skills, background in motivational interviewing desired
Strong organizational, decision making & critical thinking skills
Proficiency in Microsoft Office and working multiple platforms
Ability to build relationships and work collaboratively within an inter-disciplinary team model
Thrives in a fast paced environment
Managed care, case management, Medicare/Medicaid experience preferred
Certified Managed Care Nurse (CMCN) or Certified Case Manager (CCM) certification preferred
Bilingual (Spanish and/or Creole) preferred
The minimum level of education required for candidates in this position is a Bachelor's degree
Master's degree preferred (MSW or Nursing)
Licenses and Certifications:
- Registered Nurse with active state license in good standing
Additional Job Information:
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