Aetna Clinical Liaison UM in Norwalk, Connecticut
Req ID: 63235BR
The Clinical Liaison is clinical leader focusing on integrating member care, clinical coordination, leading the development, implementation and ongoing monitoring of program and quality initiatives to address the needs of Aetna members. They represent the plan and collaborate with providers and facilities, key stakeholders, and leadership team to enhance the quality of services provided to Aetna members and to ensure adherence to performance targets of the business area.
Fundamental Components included but are not limited to:
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 policies.
Focus on improving clinical outcomes, member and provider satisfaction within Aetna s post-acute space:
Develop and maintain strong provider relationships
Promote positive business relationships, both internal and external
Serve as a technical, professional and business resource
Analyze and report business performance data to customers and colleagues
Develop and participate in presentations and consultations to/with existing and prospective customers and provider partners
Provide appropriate, timely assistance/management of complex clinical issues and act as a resource for UM for difficult discharges
Provide feedback from provider partners to enhance business processes and infrastructure to improve operational efficiency/excellence
Participate in internal and external health industry development efforts
Support strategic and operational direction for the delivery of performance based medical management for inpatient post- acute settings
Consults and lends expertise to internal and external constituents in the coordination and administration of the UM/ benefit management function
Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization
Collaborate with various constituents/departments to identify and solution service gaps in the network
Serve as a SPOC for routine provider issues; triages and escalates issues as appropriate
Educate providers on portals, protocols, policies, procedures and services to enhance the overall member/provider experience
Serve as a liaison between facilities, staff and other internal constituents
Travel is a MUST! Up to 80% travel expectation for this position
Qualifications Requirements and Preferences:
3+ years of clinical experience in the post-acute setting (SNF, IPR, LTACH) required.
Managed care/utilization review experience preferred.
Strong verbal and written communication skills and the ability to communicate effectively with all levels of management required
Excellent consultative and communication skills, analytical ability, decisiveness, strong judgment and the ability to work effectively with staff and vendor required
Travel Required - may include weekend travel
Nursing - Registered Nurse (RN)
Management - Management - Health Care Delivery, Medical Management - Medical Management - Hospital, Nursing - Concurrent Review/discharge planning
Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel
Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality, Benefits Management - Understanding Clinical Impacts
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Consulting for Solutions
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Healthcare
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.