Aetna Clinical Health Services Manager in Woodland Hills, California
Req ID: 39867BR
Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management, and clinical coverage and polices.
Reinforces clinical programs. Communicates strategic plans. Ensures implementation of tactics. Creates direction and communicates a business case for change and key priorities to achieve business results. Identifies opportunities to implement. Accountable for meeting the financial, operational and quality objectives. Accountable for the day to day management of clinical teams. Works closely with functional area managers. Develop, monitor, and communicate performance expectations. Participate in recruitment. Assess and develop action plans. Serves as a model change agent and lead change efforts. Accountable for maintaining compliance. Ability to evaluate and interpret data. Remains calm and constructive during tense or stressful situations. Performs tasks outside area of responsibility when needed. Revises priorities to respond to change. Demonstrates a clear understanding of the California market.
5-7 years in clinical area of expertise
2-5 years clinical leadership
California HMO experience
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) in CA is required
Nursing/Certified Case Manager (CCM) is desired
Functional - Management/Management - Health Care Delivery/1-3 Years
Functional - Clinical / Medical/Concurrent review / discharge planning/4-6 Years
Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User
Technical - Aetna Applications/Strategic Contracts Manager/1-3 Years/End User
Technical - Desktop Tools/Microsoft Outlook/More Than 10 Years/End User
Technical - Aetna Applications/Access HR/1-3 Years/End User
Flexible telework / office-based schedule. Must be able to commute to Woodland Hills office for meetings.
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