Aetna (Registered Nurse) RN Manager of Care Management- San Diego in San Diego, California
Req ID: 49171BR
Aetna is currently seeking a Manager of Care Management to join our California Medicaid team in San Diego. The Manager of Care Management develops, implements, supports and promotes clinical strategies, policies and programs that drive the delivery of quality healthcare to our members. The Manager, Care Management is also responsible for the day-to-day oversight and management of clinical team processes including the organization and development of high performing teams. This is an in-office position in San Diego.
Fundamental Components of the Manager of Care Management position include, but are not limited to:
Create direction and communicate a business case for change by focusing on and addressing key priorities to achieve business results, while identifying opportunities to implement best practice approaches and introduce innovations to better improve outcomes, including evaluating and interpreting data, and meeting the financial, operational and quality objectives of the unit. If there is not a supervisor position: Day-to-day management of teams for appropriate implementation and adherence with established practices, policies, and procedures. Develop, initiate, monitor, and communicate performance expectations; and assess developmental needs and collaborate with others to identify and implement action plans that support the development of teams. Work closely with functional area managers to ensure consistency in clinical interventions supporting our plan sponsors, and participate in the recruitment and hiring process for staff using clearly defined requirements. 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. Consistently demonstrates the ability to serve as a model change agent and lead change efforts. Maintain compliance with policies and procedures and implements them at the employee level.
5-7+ years in clinical area of expertise is required 3-5+ years case management experience is required 1-3+ years leadership and supervisory experience is requiredManaged care experience is required
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Active and unrestricted Registered Nurse (RN) licensure in the State of California required. Additionally, a Certified Case Manager (CCM) certification is a plus!
Functional - Clinical / Medical/Management: < 25 employees/1-3 Years
Functional - Medical Management/Medical Management - Case Management/4-6 Years
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4-6 Years
Functional - Medical Management/Medical Management - Managed Care/Insurance Clinical Staff/4-6 Years
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User
ADDITIONAL JOB INFORMATION
1+ years managing chronic conditions is preferred.
Experience working in a regulatory environment is preferred.
Behavioral health experience is preferred.
MediCal experience is a plus.
Additional Job Skill Set Information:
Computer literacy and advanced proficiency with Microsoft Excel, Word, and web-based applications and access databases is required Ability to understand and create reports with productivity and service metrics; identify gaps Policy and procedure experience with a demonstrated ability to operationalize policies to desktops Dedicated advocate for plan and members Demonstrated ability to deliver presentations to both internal and external customers Knowledge of community resources and provider networks Presentation skills to both internal and external customers Familiarity with local health care delivery systems Experience working with diverse teams and populations Strong communication and organizational skills with an attention to detail. Ability to evaluate and interpret data, to identify areas of improvement, and focus on interventions to improve outcomes
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 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.
Job Function: Health Care