Aetna Director, Clinical Health Services in San Diego, California

Req ID: 37951BR

POSITION SUMMARY

This position oversees the implementation and on-going execution of the strategic and operational business plan for the business segment's clinical operations, inbound/outbound call queue, implementation, and/or plan sponsor operations. Coordinates business segment policies and procedures in support of financial, operational and service requirements. Offices anticipated in San Diego and Sacramento.

Fundamental Components:

  • Develop and manage clinical operations focused on improving clinical and financial outcomes, member engagement, and satisfaction

  • Serve as liaison with regulatory and accrediting agencies and other health business units

  • Formulate and implement strategy for achieving applicable department/unit metrics and provide operational direction

  • Serve as technical, professional and business resource (may cross multiple business functions)

  • Develop and participate in presentations and consultations to existing and prospective customers

  • Direct/provide enhancements to business processes, policies and infrastructure to improve operational efficiency (may cross multiple business functions)

  • Participates in internal and external health industry development efforts

  • Develop, implement, and evaluate policies and procedures, which meet business needs (may cross multiple business functions)

    Implements and monitors business plan and oversees any implementations or business transitions impacting service operations.

  • Collaborates and partners with other business areas across/within regions or segments and within other centralized corporate areas to ensure all workflow processes and interdependencies are identified and addressed on an on-going basis.

  • Promote a clear vision aligned with company values and direction; sets specific challenging and achievable objectives and action plans; motivates others to balance customer needs and business success; challenges self and others to look to the future to create quality products, services, and solutions.

    BACKGROUND/EXPERIENCE desired:

  • 8-10 years clinical leadership required

  • Ability to synthesize program performance and clinical outcomes

  • Managed care experience required

  • Demonstrated management experience selecting, motivating and leading teams; mentoring and coaching staff

  • Exceptional communication skills, verbal, written and presentation

  • Proficiency with MS Office Suite, applications

    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 - Clinical / Medical/Management: < 25 employees/7-10 Years

    Functional - Medical Management/Medical Management - Managed Care/Insurance Clinical Staff/7-10 Years

    Functional - Clinical / Medical/General Management/7-10 Years

    Functional - Leadership/Act as company spokesperson to external constituents/7-10 Years

    TECHNOLOGY EXPERIENCES

    Technical - Desktop Tools/Microsoft Word/7-10 Years/End User

    Technical - Desktop Tools/Microsoft SharePoint/7-10 Years/End User

    Technical - Desktop Tools/TE Microsoft Excel/7-10 Years/End User

    Technical - Desktop Tools/Microsoft Outlook/7-10 Years/End User

    ADDITIONAL JOB INFORMATION

    -Master's degree in behavioral health field; or

    -Registered Nurse (Masters preferred): and-Active unrestricted State Licensure in applicable functional area. (eg RN, LPC, LCSW)

    -7-10 years of managed care experience required, and at least 3 years experience required in California delegated model either with a health plan or IPA interfacing with external Medical Management partner(s)

    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.

    #LI-HL1

Job Function: Health Care