Aetna Senior Director of Clinical Operations - 45587BR in Hartford, Connecticut
Req ID: 45587BR
Reports to the Head of Clinical Services overseeing all PreCert & Specialty PreCert operations, ICC oversight and all associated projects within this scope. Also responsible for Policy/Design of PreCert workflow, new program development and automation.
Accountable for managing staff of >1000 stateside and offshore staff
Budget of $130M; Develops department budget and controls department expenses while meeting service requirements.
Accountable for delivering National PreCert operations for Commercial and Medicare lines of business (X M members)
Responsible for development and management of Specialty PreCert teams addressing rare and complex conditions as well as infertility
Accountable for management of offshore International Clinical Center of Excellence to deliver services across 2 vendors in 3 countries inclusive of workflow development performance management and strategic direction.
Develop and promote positive business relationships internally and externally.
Build strong high performing teams through training, stretch assignments, coaching, performance management and other development techniques.
Accountable for the development, implementation and evaluation of policies and procedures, which meet business, regulatory and accreditation needs.
Maintains a working knowledge of legislative changes that may potentially affect quality and care management practices and standards.
Drive strategic initiatives inclusive of program design, strategic precert automation and other efficiency improvements.
10 years clinical/managed care/health care industry experience.
Previous management experience in a managed care organization required
Multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes.
Proven track record managing complex projects/budgets resulting in cost savings.
The highest level of education desired for candidates in this position is a Master's degree.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is desired
Flexible telework / office-based schedule (can live near any office location)
ADDITIONAL JOB INFORMATION
Looking for a strong decision-maker, analytical and organized with excellent negotiation skills.
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.
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Job Function: Health Care