Aetna CA MCD Mgr, UM in San Diego, California

Req ID: 37952BR

POSITION SUMMARY

Oversight of delegated medical groups.

Fundamental Components:

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.

BACKGROUND/EXPERIENCE desired:

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.

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 is desired

Mental Health/Licensed Clinical Social Worker is desired

Mental Health/Licensed Professional Counselor is desired

FUNCTIONAL EXPERIENCES

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