Aetna Licensed Case Management Supervisor [Southwest Region] (VA MCD) in Bristol, Virginia
Req ID: 43064BR
JOIN OUR GROWING TEAM
Please note that we have multiple current openings for the Licensed Case Management Supervisor role in the Bristol/Southwest Virginia region.
The position will be responsible for covering the Bristol, Wytheville, Marion, Galax, Big Stone Gap or Pennington Gap region.
The Licensed Case Management (CM) Supervisor is responsible for oversight of healthcare management staff including the organization and development of high performing teams. Works closely with functional area managers to ensure consistency in clinical interventions supporting our members. Accountable for meeting the financial, operational and quality objectives of the unit. Please note that this position is located in the Bristol/Southwest Virginia region.
Oversees the implementation of healthcare management services for assigned functional area 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 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 Create 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.
3 - 5 years in clinical area of expertise Ability to communicate effectively with Providers, Members, Staff and other Leaders both in oral and written formats. Ability to evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes. Ability to work with people in such a manner as to build high morale and group commitment to goals and objective
The highest level of education desired for candidates in this position is a Master's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
One of the following active clinical licenses is required:
Nursing/Registered Nurse (RN)
Mental Health/Licensed Clinical Social Worker (LCSW)
Mental Health/Licensed Professional Counselor (LPC)
Functional - Medical Management/Medical Management - Case Management/4-6 Years
Functional - Medical Management/Medical Management - Managed Care/Insurance Clinical Staff/4-6 Years
Functional - Clinical / Medical/Management: < 25 employees/1-3 Years
ADDITIONAL JOB INFORMATION
Master's degree in behavioral health field; or Registered Nurse (BSN preferred): and Active unrestricted State Licensure in applicable functional area. (eg RN, LPC, LCSW) -1-3 years of CM experience is preferred; MLTSS experience strong desired. MCO experience is highly desired. Minimum of 1-3 years supervisory experience. Reporting: ability to understand and create reports with productivity and service metrics; identify gaps May provide support to the sales staff & network staff via onsite customer visits and/or presentations) 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. Field based travel with personal vehicle required. Must have dependable transportation, valid and active VA driver's license and proof of vehicle insurance.
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.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
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Job Function: Health Care