Aetna Registered Nurse (RN) - Clinical Health Services Supervisor - 50345BR in New York, New York

Req ID: 50345BR

Please note: This is an in office role located at 55 West 125th Street New York, NY 10027, 4 days work from home after 3-6 month orientation and demonstrated proficiency

POSITION SUMMARY

The Registered Nurse (RN) - Clinical Health Services Supervisor is responsible for management of medical services staff including the organization and development of high performing teams. Works closely with managers (re: Case/Disease Management) ensuring consistency in care management interventions across membership. Facilitates effective interfaces among team members, as well as across teams, providers and Aetna departments. Responsible for the day-to-day implementation of Aetna's medical management services policies and procedures. Accountable for meeting the financial, operational and quality objectives of the unit.

Fundamental Components:

  • Oversees the implementation of Aetna medical management services including but not limited to Inpatient Care Coordination/Discharge Planning/Case Management/Disease Management/Precertification and monitors daily performance to ensure business goals are met and compliance with Aetna policies and procedures is maintained

  • Implements clinical policies & procedures in accordance with NCQA, URAC, state and federal standards and mandates

  • Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking

  • Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care

  • May act as a liaison between National Care Management Program Design, Specialty Services and other National Care Management programs to ensure successful implementation of continuum of care programs

  • May develop/assist in development and/review new training content

  • May collaborate/deliver inter and intra-departmental training sessions

    BACKGROUND/EXPERIENCE desired:

  • Ability to communicate effectively with Providers, Members, and Staff & Upper Management in both an oral and written format.e.g., may provide support to the sales staff & network staff via onsite customer visits and/or presentations is required

  • Ability to evaluate and interpret clinical and utilization data, identify areas of improvement, and focus on interventions to improve outcomes is required

  • Able to work with people in such a manner as to build high morale and group commitment to goals and objectives.

    Computer literacy and experience familiarity with Excel, MS Word, and web-based applications is required

  • MLTC (Managed Long Term Care) experience is preferred

    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/Case Management/4+ Years

    Functional - Management/Management - Health Care Delivery/1+ Years

    TECHNOLOGY EXPERIENCES

    Technical - Desktop Tools/Microsoft Outlook/4+ Years/End User

    Technical - Desktop Tools/Microsoft PowerPoint/1+ Years/End User

    Telework Specifications:

    4 days work from home after 3-6 month orientation and demonstrated proficiency

    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 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