Aetna Continuum of Care Manager (RN) in Phoenix, Arizona

Req ID: 53321BR

This role is work at home. In office training may be required.

POSITION SUMMARY The Continuum of Care Manager is accountable to the UM Sr. Director for participating in the development, implementation & ongoing monitoring of program initiatives to address the needs of Aetna members. The Manager collaborates with regional Medical Directors, Utilization & Care Management plan leadership to enhance the service quality provided to Aetna members & to ensure adherence to performance targets developed by CMS, NCQA & the regions. Involved in initiative planning, ongoing client relationship management and satisfaction for assigned initiatives that impact the delivery of products and services to the internal and external environment. Collaborates with external vendors, external consultants, consulting team members and/or matrixed staff as required in support of initiatives. Accountable for transferring knowledge, best practices, methodology and tools to client organizations. Participates as a team member, may be responsible for concurrent initiatives or act as team lead for less complex projects based on resource requirements. Fundamental Components/Job Description:•Identifies UM training needs through observation, audit results & evaluation of UM reports, & collaborates with Learning & Performance to ensure development and implementation of training programs as needed to support UM process.•Responds to issues and inquiries initiated by UM leadership at the local markets & works to identify potential solutions•Collaborates with Medical Directors, UM Team Managers and Supervisors to monitor the quality of UM interventions & develop corrective action as neededParticipates in national efforts to develop effective methods to identify members prior to an acute care episode who are appropriate for Continuum of Care programs. Also participates in the development of workflows and tools and functions as a resource to the UM Manager and Supervisor in implementing new workflows and tools.•Liaison for segment relationships around utilization management regional activities, site visits related activities surrounding UM•Establishes effective liaison with all regional care teams by building strong relationships and professional rapport with UM Managers and other members of the Care Management Team.•Designs, develops interventions and facilitates work sessions. Develops and delivers all required analysis, reporting and presentation materials•Supports holistic solutions and/or key strategic plans. Proactively identifies opportunities for improvement within assigned initiatives•Gathers, analyzes and synthesizes business intelligence to drive achievement of strategic business objectives •Builds and utilizes diverse internal and external networks, as appropriate, for data gathering and best practice identification. Leverages internal and external networking to drive optimal initiative results and knowledge/best practice transfer Background/Experience 2 years minimum experience in Utilization Management, including Prior Authorization or Concurrent Review is required3-5 years experience supervising Clinical Staff is required

Aetna experience as a supervisor or manager preferred1-2 years experience in other care management programs preferred3-5 years experience in a clinical setting requiredRN is requiredBS degree in nursing preferred Additional Candidate InformationWorks with collaborative & resourceful team who is willing to help out & problem solve to meet objectivesWork at home opportunity after training periodTeam members must be able to work independently given remote nature while collaborating & working w/ remote teamSeeking candidate who is flexible with time & duties given that UMSS supports the Medicaid markets with differing needs. Clinical Ops moves quickly & focus shifts depending on business needs, incl. travel to local markets.


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.

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Job Function: Health Care

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.