Aetna Clinical Health Services Supervisor in New Albany, Ohio
Req ID: 49577BR
This is an office based role in New Albany, OH
The A1A Supervisor of Clinical Services, is responsible for oversight of the clinical team supporting the AetnaOne Advocate Program. The Supervisor is responsible for leading a team of 15-20 clinical resources and non-clinical resources and development of a best in class, high performing team and is accountable for meeting the financial, operational and quality objectives of the unit. The Supervisor works closely with the A1A Manager as well as the other functional area Managers to ensure consistency in clinical interventions, implementation of clinical policy and processes to ensure the delivery of high quality clinical programs and services.
Fundamental components include but are not limited to:
Oversees the implementation of clinical management services for A1A customers in assigned pods Reinforces clinical philosophy, 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. 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 collaborate with others to identify and implement action plans that support the development of high performing teams. May act as a single point of contact in conjunction with the A1A Manager for the customer and the Account Team which includes participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers. Evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes. Ensures implementation of tactics to meet strategic direction for cost and quality outcomes. Works to ensure consistency in clinical interventions supporting our plan sponsors. 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.
5 years in clinical area of expertise required
Managed care experience is preferred
Prior management experience is preferred
RN with current, unrestricted licensure in state in which work is being done required
Willingness to obtain RN licensure in other states as needed
BSN or relevant experience required
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is required
Nursing/Certified Case Manager (CCM) is desired
Functional - Nursing/Case Management/4-6 Years
Functional - Nursing/Concurrent Review/discharge planning/4-6 Years
Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/Power User
Technical - Aetna Applications/Aetna Strategic Desktop Reporting/1-3 Years/Power User
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
This is an in office position only. There is no Work at Home.
ADDITIONAL JOB INFORMATION
Demonstrates highly developed communication and people skills. Ability to engage and interact easily with diverse group of individuals. Strong listener, empathetic and supporting. Ability to prioritize and multitask in fast paced, deadline driven environment. Ability to adapt to constantly changing demands and environment. Strong public speaking and presentation skills. Demonstrates a commitment to service; accountable for actions and issues resolution, responsive to customer needs. Ability to work with people in such a manner as to build high morale and group commitment. Demonstrates strong problem solving skills and ability to work independently. Ability to evaluate and interpret data, identify areas for improvement and focus on interventions to improve outcomes. Requires proficiency with computer skills including keyboarding, navigating multiple systems. Proficiency in use of Microsoft Outlook and Office. Must be able to work in office setting with extended periods of time sitting, talking on telephone and typing on computer.
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