Aetna Registered Nurse (RN) - Prior Authorization Supervisor - Sign On Bonus! (CA MCD) - 48370BR in San Diego, California
Req ID: 48730BR
JOIN OUR CLINICAL TEAM
Aetna Better Health of California in San Diego, is offering a $3,000 Sign On Bonus for this position. We are looking for people who value excellence, integrity, caring, and innovation. In this role, you will be building a team dedicated to improving the lives of the most vulnerable in our population.
Join the company that is changing the face of health care across the nation. Aetna Better Health of California is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you'll join a team dedicated to improving the lives of the most vulnerable in our population. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of California, and we will support you all the way.
The Licensed RN Prior Authorization Supervisor will be responsible for overseeing the healthcare management staff including the organizing and developing high performing teams. Additionally, the Licensed RN Prior Authorization Supervisor will collaborate with area managers to ensure consistency in clinical interventions supporting out members. The Licensed RN Prior Authorization Supervisor will also be accountable for meeting the financial, operational, and quality objectives of the unit.
Fundamental Components and Responsibilities of the Prior Authorization Supervisor:
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
Required Qualifications and Education of the Licensed RN Prior Authorization Supervisor:
3+ years of experience in a clinical setting. 1+ years of direct experience within prior authorization and/or precertification. 1+ years of supervisory or management experience. RN with active and unencumbered CA license is required; Bachelor of Nursing (BSN) is preferred Previous managed 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 good-standing Registered Nurse (RN) license in the State of California required.
Functional - Medical Management/Medical Management - Precertification/1-3 Years
Functional - Medical Management/Medical Management - Concurrent Review/1-3 Years
Functional - Clinical / Medical/Management: < 25 employees/1-3 Years
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4-6 Years
Functional - Clinical / Medical/FE Clinical coverage & policies/1-3 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 SharePoint/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
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.
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