Aetna Clinical Health Services Supervisor in Philadelphia, Pennsylvania
Req ID: 44528BR
Work at Home is possible, but not guaranteed. Candidates should be commutable to central PA for travel as needed. May be required to be "on call" once every two months on the weekend.
POSITION SUMMARYThe 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.
FUNDAMENTAL COMPONENTS: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.
BACKGROUND/EXPERIENCE 2 years + Experience with Utilization Management or Concurrent Review is required. Prior experience in Management or Team Leader is preferred. RN License is required Experience in collaborating with others to achieve desired results is required Strong written and verbal communication skills are required LICENSES AND CERTIFICATIONSRegistered Nurse (RN)EDUCATIONThe minimum level of experience for this role is an Associate's degree or equivalent experience.
ADDITIONAL CANDIDATE INFORMATION: Utilization Management (Precertification) Review preferred. Required Skills-Supporting Medical Practice, Understanding Clinical Impacts, and Leveraging Technology Desired Skills-Turning Data into Information, Collaborating for Results, Providing Solutions to Constituent
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Job Function: Health Care