Aetna CA MCD Mgr, UM in San Diego, California
Req ID: 37952BR
Oversight of delegated medical groups.
Reinforces clinical philosophy, programs, policies and procedures. Communicates strategic plan and specific tactics to meet plan. Ensures implementation of tactics to meet strategic direction for cost and quality outcomes. Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results. Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes. Accountable for meeting the financial, operational and quality objectives of the unit. May be accountable for the day-to-day management of teams for appropriate implementation and adherence with established practices, policies and procedures if there is not supervisor position Works closely with functional area managers to ensure consistency in clinical interventions supporting our plan sponsors. Develop, initiate, monitor and communicate performance expectations. May act as a single point of contact for the customer and the Account Team which includes 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. Consistently demonstrates the ability to serve as a model change agent and lead change efforts. Accountable for maintaining compliance with policies and procedures and implements them at the employee level. Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.
5-7 years in clinical area of expertise.
MCO experience is required; minimum of 3-5 years in MCO setting strongly preferred;
Minimum of 1-3 years supervisory or management experience.
Behavioral health experience is strongly preferred.
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 is desired
Mental Health/Licensed Clinical Social Worker is desired
Mental Health/Licensed Professional Counselor is desired
Functional - Medical Management/Medical Management - Concurrent Review/7-10 Years
Functional - Clinical / Medical/Concurrent review / discharge planning/7-10 Years
Functional - Clinical / Medical/Management: < 25 employees/4-6 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. (e.g. RN, LPC, LCSW)
Reporting: ability to understand and create reports with productivity and service metrics; identify gaps
Dedicated advocate for plan and members
Demonstrated ability to deliver presentations to both internal and external customers
Knowledge of community resources and provider networks
Familiarity with local health care delivery systems
Experience working with diverse teams and populations
Strong communication and organizational skills with an attention to detail.
Policy and procedure experience with a demonstrated ability to operationalize policies to desktops
Ability to evaluate and interpret data, to 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 objectives
Computer literacy and advanced proficiency with Microsoft Excel, Word, and web-based applications and access databases is required
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.
Job Function: Health Care