Aetna Supervisor, Clinical Health Services - 49395BR in New Albany, Ohio

Req ID: 49395BR

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.

POSITION SUMMARY

The Clinical Health Services Supervisor will be 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. The successful candidate for this job will be responsible for supervision of staff and processes.

This job involves rotation to on call on weekends 1-2 times per month and working until 8 pm 1 - 2 times per week. Associated with receiving and processing requests for Prior Authorization of services submitted by Providers and Members.

Fundamental Components but not limited to the following:

Oversees the implementation of healthcare management services. Implements clinical policies and procedures in accordance with applicable regulatory and accreditation standards. Serves 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. Develop, initiate, monitor and communicate performance expectations.

BACKGROUND/EXPERIENCE:

Minimum of 5 years in clinical area of expertise in managed care.

Supervisory experience required at least 3 years at least a team of 10 or more.

Able to communicate effectively with Providers, Members, staff and other Leaders both in oral and written formats.

Able to evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes. Able to work with people to build high morale and group commitment to goals and objectives.

Computer literacy required.

EDUCATION

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

FUNCTIONAL EXPERIENCES

Functional - Nursing/Medical-Surgical Care/4-6 Years

Functional - Medical Management/Medical Management - Managed Care/Insurance Clinical Staff/1-3 Years

Functional - Medical Management/Medical Management - Clinical claim review/1-3 Years

FunctionalExperience/FunctionalFocus/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Call Management/CMS/1-3 Years/End User

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

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

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

ADDITIONAL JOB INFORMATION

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.

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Job Function: Health Care