Aetna Utilization Management Supervisor (RN) in New Albany, Ohio
Req ID: 52216BR
Please note: This is an in office position in New Albany, OH
The UM Supervisor will be responsible for overseeing the UM department staff including the organizing and developing high performing teams; will collaborate with other medical management supervisors/managers to ensure consistency in clinical interventions supporting our members; and will also be accountable for meeting the financial, operational, and quality objectives
Oversee the implementation of healthcare management services for assigned functional area Implement 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
Ensure the implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care
Partake in the development and implementation of inter/intra-departments trainings
Protect the confidentiality of member information and adhere to company policies regarding confidentiality
Manage resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating and documenting of care
Develop, initiate, monitor and communicate performance expectations as well as ensure the team's understanding and use of information system capability and functionality
Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills
Collaborate with others to identify and implement action plans that support the development of high performing teams 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 demonstrate the ability to serve as a model change agent and lead change efforts
Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, as needed
RN with active and unencumbered license is required; Bachelor of Nursing (BSN) is preferred
3+ years of experience in a clinical setting is required
1+ years of direct experience within utilization management, prior authorization and / or precertification required
1+ years of supervisory or management experience required
Previous managed care experience is required.
Behavioral health experience is preferred
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
ADDITIONAL JOB INFORMATION
Ability to work with people in such a manner as to build high morale and group commitment to goals and objective. Experience with reporting: ability to understand and create reports with productivity and service metrics; identify gaps. Demonstrated computer literacy and advanced proficiency with Microsoft Excel, Word, and web-based applications and access databases is required. Knowledge of community resources and provider networks. Experience working with diverse teams and populations. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. Medicaid Experience/Knowledge highly desired.
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 candidates'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