Aetna Clinical Care Management Supervisor - 45283BR in Tampa, Florida
Req ID: 45283BR
The Clinical Care Management Supervisor is responsible for the direct supervision, guidance and job performance of a team of community care managers, working within the field in the local geography. Their team will include nurse care managers (RNs), social workers and community health resource specialists, aligned to a Florida geography, serving high risk commercial and Medicare Advantage members in a new innovative community based program, and provides individual and team oversight of productivity and quality performance to optimize member well being, clinical and cost effective outcomes.
Provides direct supervision and guidance to a community based team that includes RN Care Managers, Social Workers (LCSW) and Community Health Resource Specialists, working within the field in the local geography, monitoring job performance and promoting individual and team quality performance and productivity
Prepares, analyzes and applies pertinent data, metrics and reports to monitor and enhance quality, productivity, and assure adherence to policy and procedures
Contributes to associates on-boarding, coaching and ongoing education to build individual and team competencies and performance
Responsible for the teams administrative oversight, i.e. team meetings, time and attendance, caseload balance and associate performance
Ability to manage a mixed work sight/field and virtual, work at home team
Conducts individual and team quality reviews/audits as required, including home visit ride alongs, monitoring associate performance and adherence to documentation procedures
Provides clinical guidance and serves as an expert resource to the care team and assists with member care management case reviews and consultations
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
Provides clinical expertise and business direction to drive the effective execution of care management services
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
Other responsibilities as required
5+ years clinical experience required
2+ years supervisory experience required
Managed Care, Medicare/Medicaid experience required
Local travel is required
Ability to work flex hours
Candidate must reside in specific state/location where role is located
Case Management experience preferred
Understanding of a local, community based, care management model, delivered both in person and telephonically
Experience in home health, public health, community health (high risk populations preferred)
Excellent written/verbal communication skills; background in motivational interviewing desired
Strong organizational & critical thinking skills
Experience in managing a mixed work site and virtual team
Ability to build relationships and work collaboratively within an inter-disciplinary team model
Bilingual (Spanish and/or Creole) preferred
The minimum level of education required for candidates in this position is a Bachelor's degree (BSN) in public health or other relevant disciple preferred
Masters degree preferred (MSW or Nursing)
Licenses and Certifications:
Active clinical licence (RN or LCSW), active and in good standing
Certified Managed Care Nurse (CMCN) or CCM preferred
Florida Home Base is placeholder only. Positions will be geographically located. Specific positions will be outlined in recruiter's notes below.
Candidate will work in either Jacksonville, Tampa or Sunrise office based on location, ability to work from home otherwise
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