Aetna Manager, Medical Management in Tampa, Florida
Req ID: 43347BR
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.
The Manager for Medical Management is responsible for managing the clinical validation program in bill review for Worker's Compensation. Manage Business Process Sourcing with multiple vendors. Ensures compliance with corporate and regulatory procedures.
This role will drive revenue growth and profitability thru operational performance. This role will implement CV Products that exceed Client Expectations. Encourage high performing behavior and a great place to work.
Provides clinical management interface for clients and providers for problem resolution. Educates clients about programs and processes. Acts as an internal resource for account management and other departments for clinical issues, programs, and processes. Evaluates and analyzes data to assure operational effectiveness while meeting or exceeding client objectives. Ensures compliance to corporate, quality assurance, state and federal procedures. Assists in the development, definition, implementation and evaluation of new and improved programs and processes. Assists in the development and implementation of the department business plan. Participates in the budgetary process including preparation of a departmental budget and monitoring for adherence to ensure growth and profitability. Recruits, develops and mentors management team. Develops and communicates personnel strategies. Participates in tactical execution as required to support management
Registered Nurse (RN) with active state license in good standing in the state where job duties are performed
Significant (5-7 years) health care, clinical, and/or insurance industry experience required.
Excellent Comprehensive Knowledge of utilization review, case management, and/or workers compensation.
Excellent written and verbal communication and presentation skills.
BR4, Outlook, Ad Hoc reporting, MS Excel and Word is needed.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Claims/ is desired Leadership/ is desired Medical Management/ is desired Nursing/ is desired
Functional - Claims//4-6 Years
Functional - Medical Management/Medical Management - Coding/4-6 Years
Functional - Leadership/Lead a business in different geographies or multiple markets/4-6 Years
Functional - Nursing/Clinical claim review and coding/4-6 Years
Functional - Quality Management/Quality Management/4-6 Years
Technical - Aetna Applications//4-6 Years/End User
Technical - Computer Operations//4-6 Years/End User
Technical - QA Tools//4-6 Years/End User
ADDITIONAL JOB INFORMATION
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.
Job Function: Workers' Compensation