Aetna UM Clinical Team Lead (RN) - 51453BR in Houston, Texas

Req ID: 51453BR

This exciting opportunity sits onsite in our Houston, TX office!

Hours for the role are 8:00AM-6:00PM (potential monthly rotating weekend/holiday shift)

POSITION SUMMARY

The candidate requires a deep passion for our members and the ability to work with members through difficult situations and creates cross functional solutions that enable our teams to best help our members. This position has no supervisory oversight of staff, but requires a solid understanding of the clinical workflows, clinical policies and procedures to ensure provider and member needs are meeting expectated clinical policies. This role is a champion for members / providers through call resolution of clinical questions by building trust and providing a clear path to care. The Champion will influence process improvements that support streamlining workflows and enforcing best practices. They may lead projects as assigned. The Champion provides ongoing communication and updates to leadership and contributes and participates in team meetings.

Fundamental Components:

Demonstrates empathy for constituents needs and priorities.Serves as a content model expert and mentor to the team regarding practice standard, quality of interventions, problem resolution and critical thinking.Demonstrates ability to promote cooperation and team-building between all department members and meet expectations and key performance measures.Serves as a resource to team members.Mentors the team; monitoring and providing feedback regarding performance relative to best practices.Acts as a role model for the Aetna values, particularly regarding company policies on confidentiality.Communicates effectively with a variety of audiences.

Well organized and able to prioritize tasks.

BACKGROUND/EXPERIENCE:

3-5+ years of clinical experience requiredRegistered Nurse (Licensure in TX required)Managed Care experience preferred2+ years of Utilization Management experience required2+ years of Precert experience preferredExcellent critical thinking skillsComputer literacy (Microsoft Outlook, Excel and Word)Strong customer service skills

EDUCATION

The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse is required

FUNCTIONAL EXPERIENCES

Functional - Nursing/Medical-Surgical Care/3-5+ Years

Functional - Nursing/Clinical claim review and coding/1-3+ Years

Functional - Nursing/Legal and benefit interpretation/1-3+ Years

Functional - Clinical / Medical/Direct patient care (hospital, private practice)/3-5+ Years

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/Aetna Total clinical View/1-3+ Years/End User

Technical - Aetna Applications/Aetna Strategic Desktop Reporting/1-3+ Years/End User

Technical - Desktop Tools/Microsoft Outlook/1-3+ Years/End User

Technical - Desktop Tools/Microsoft Word/1-3+ Years/End User

ADDITIONAL JOB INFORMATION

Please note office is located at 14955 Heathrow Forest Pkwy, Houston, TX.

Join our Clinical Services team and help shape a new way to support our members. Health insurance is changing and we are testing out a new way to organize our Clinical services team to change how our member and provider communities are supported. In this new model, you will be part of a team tasked to help design and test new ways of working to deliver a better consumer experience. You can influence the future of health care and make a difference!

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 hereto review the benefits associated with this position.

Aetna takes our candidate'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.

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Job Function: Health Care