Aetna Supervisor, Clinical Health Services in Princeton, New Jersey
Req ID: 53895BR
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.
Oversees the implementation of healthcare management services for MLTSS Department 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
Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care and may act as a liaison with other key business areas. May develop/assist in development and/review new training content May collaborate/deliver inter and intra-departmental training sessions
Protects the confidentiality of member information and adheres to company policies regarding confidentiality
Manages 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
Ensures the team's understanding and use of information system capability and functionality
May have responsibility for their own case load work
May act as a single point of contact for the customer and the Account Team including: participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.
Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills
Assesses developmental needs and collaborates 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 demonstrates the ability to serve as an model change agent and lead change efforts
Creates a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when needed
Accountable for maintaining compliance with policies and procedures and implements them at the employee level.
The MLTSS Supervisor is responsible for oversight of MLTSS care management staff including the organization and development of a high performing team.
Required to work closely with leadership to ensure consistency in clinical interventions supporting our members. Accountable for meeting the financial, operational and quality objectives of the department.
Required to have a minimum of 1 year paid professional experience working with and assessing the needs of the elderly or physically disabled in an institutional or community setting.
1 year of care management experience is required
Required to be a licensed registered nurse in the state of New Jersey.
A minimum of 2+ years management experience is preferred
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Nursing License (RN) is required
Telework will be available following a 6-8 week orientation period
Candidates will be required to work in the office at a minimum of 1 day per week following orientation period
ADDITIONAL JOB INFORMATION
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
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.