Aetna Director, Long Term Services in Sunrise, Florida

Req ID: 37926BR

POSITION SUMMARY

This position will lead the Florida Medicaid LTSS team including over 100 case managers and nurses who arrange for services for approximately 5,000 LTSS members in 4 Regions. The position includes management of all LTSS processes and operations, ensuring contract compliance, and compliance with significant state reporting, case management, and operational requirements.

Fundamental Components:

Seeking individual with significant LTSS experience, preferably at the Director level or above, to manage dynamic Aetna LTSS clinical operations in Florida across four regions. Excellent opportunity for experienced LTSS leader who fully understands the LTSS program requirements and has demonstrated experience managing all operational and clinical aspects of the LTSS program. Individual should have experience and success managing a large team, experience working with state Medicaid management, and proven ability to manage and improve operations. Position includes:

  • Directing the overall delivery of services provided to disabled and frail elderly population who qualify for skilled nursing facility placement with the goal of keeping members in a home based setting or moving members from nursing facilities to a home based setting

    Developing policies and procedures that Social Workers will use in their daily interaction with members to evaluate personal care needs, activities of daily living, and continuum of care through development of a care plan, appropriate social work assessments, telephone follow-up, and in-home assessments. Promotes ease of access of care through case management, information, authorizations, and referrals.

    Directing contracting activity with various state and local agencies to provide a wide range of services for a specialized population.

    Evaluating care delivery alternatives to ensure high quality, and cost effective services. Determines cost containment measures which complement quality of care.

    Serves as point of contact with all regulatory agencies. Ensures compliance with Department of Elder Affairs, Agency for Health Care Administration, and Department of Children and Families standards on an ongoing basis. Provides oversight for preparation of all audits.

    Develops guidelines for utilization of services and case staffing.

    Serves as point of contact for integration of all interdepartmental processes within the company to ensure a high quality of life for the membership being serviced, as well as compliance with all regulatory guidelines.

    Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions.

  • Identifies and develop processes to improve staff efficiency and effectiveness.

    BACKGROUND/EXPERIENCE desired:

    Complies with all state requirements in the state where job duties are performed.

    Significant (7-10 years) experience in medical social work or case management required.

    Previous (3-5 years) management experience required.

    Knowledge of casework and group work principles, practices, and methodology. Extensive knowledge of community resources.

    Knowledge of the state regulations

    EDUCATION

    The highest level of education desired for candidates in this position is a Master's degree.

    LICENSES AND CERTIFICATIONS

    Nursing/Registered Nurse (RN) is required or

    LCSW is required

    FUNCTIONAL EXPERIENCES

    Functional - Leadership/Lead a complex or multifunctional organization/4-6 Years

    Functional - Leadership/Act as company spokesperson to external constituents/4-6 Years

    Functional - Management/Management - Health Care Delivery/4-6 Years

    Functional - Clinical / Medical/General Management/4-6 Years

    ADDITIONAL JOB INFORMATION

    Opportunity to join dynamic team in well-established, innovative, growth oriented organization. Opportunity to help high risk population and contribute to operational excellence.

    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