Aetna Training & Qual Clinician in Hartford, Connecticut
Req ID: 54642BR
Responsible for conducting audits of current processes, reports, and procedures to identify process improvements and issue resolutions. Develops and conducts medical management staff training based on outcomes of clinical audits.
Identifies, documents, and reports any transaction errors in a timely manner to ensure prompt resolution.
Tracks and trends audit results, providing feedback to management. Recommends corrective action and facilitates the implementation of remedial and process improvement plans. Develops and conducts medical management staff training based on outcomes of clinical audits. Implements training programs to increase role specific consistencies and efficiencies related to process work flows. Measures outcomes of clinical staff training and identifies key findings to ensure effective alignment of training content and method of delivery with business objectives and staff performance requirements. Promotes continuing compliance with accreditation and/or applicable regulatory body requirements including but not limited to: companys ethical, fraud, abuse, and compliance policies and expectations, utilization management policies, procedures and workflows, key accreditation standards, and HIPAA regulatory standards related to use of PHI. Facilitates communication of relevant findings to corporate Compliance Department and/or Corporate Privacy/ Security Officer. Performs other duties as required including flexibility with possible on-call business needs.
Previous 3+ years' experience in a managed care clinical operations environment (utilization management, case management, and/or behavioral health case management) required.
Experience in designing, developing, and instructing training programs.
Excellent verbal and written communication skills.
Strong data analysis and report preparation skills.
Ability to use standard corporate software packages and corporate applications.
Preferred Experience in QNXT platform
The minimum level of education required for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS:
RN active and unrestricted in any state is required
Functional - Quality Management/Quality Management/1+ Years Experience
Technical - Aetna Applications/QNXT/1+ Years Experience/End User
ADDITIONAL JOB INFORMATION:
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.
Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Health Care
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.