Aetna Health Service Manager 37914BR in Atlanta, Georgia

Req ID: 37914BR

POSITION SUMMARY:

Health Services Managers develop, implement, support, and promote Specialty Pharmaceutical strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna.

Fundamental Components:

  • Manage Internal and External vendors, customers and stakeholders on behalf of Specialty Strategy & Clinical Management team.

  • Define resource requirements for policy and program development / maintenance / measurement.

  • Develops clinical management programs that optimize quality of patient care and healthcare costs.

  • Be responsible for Policy, Appeal and Specialty Clinical program(s) Quality Assurance and review.

  • Coordinates pharmacy related data requests and research (within Aetna, healthcare industry, pharmacy companies, government and/or academia) to drive achievement of strategic business objectives.

  • Be responsible for managing escalated patient and medical director issues.

  • Support holistic solutions and/or key strategic plans as they relate to Specialty drug management.

  • Proactively identifies opportunities for improvement within assigned initiatives.

  • Share joint accountability for initiatives return on investment.

    BACKGROUND/EXPERIENCE desired:

  • Technical/professional of clinical expertise and experience relevant to business area.

  • RN, BSN with active license.

  • In-depth knowledge and experience in managed care / managed pharmacy / competitive environment.

  • 5+ years clinical experience, in addition to 5+ years experience in pharmacy related industry, or equivalent.

  • Leadership experience preferred.

    EDUCATION:

    The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

    LICENSES AND CERTIFICATIONS:

    Nursing/Registered Nurse (RN) is required

    FUNCTIONAL EXPERIENCES:

    Functional - Nursing/Disease management/1-3 Years

    Functional - Nursing/Clinical coverage and policies/4-6 Years

    Functional - Nursing/Drug Information & Safety/1-3 Years

    Functional - Medical Management/Medical Management - Direct patient care/4-6 Years

    TECHNOLOGY EXPERIENCES:

    Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User

    Technical - Database/Intuit QuickBase/1-3 Years/End User

    Technical - Aetna Applications/Aetna Pharmacy Management Claim Adjudication Sys/1-3 Years/Power User

    REQUIRED SKILLS:

    Benefits Management/Supporting Medical Practice/FOUNDATION

    Benefits Management/Understanding Clinical Impacts/ADVANCED

    Leadership/Collaborating for Results/ADVANCED

    DESIRED SKILLS:

    Leadership/Developing and Executing Strategy/ADVANCED

    Benefits Management/Maximizing Healthcare Quality/ADVANCED

    Benefits Management/Interacting with Medical Professionals/MASTERY

    Telework Specifications:

    Full-Time Telework (WAH)

    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 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.

    #LI-EG1

Job Function: Health Care