Aetna Registered Nurse (RN) Supervisor Prior Authorization - KS MCD - 51761BR in Overland Park, Kansas
Req ID: 51761BR
Aetna Better Health of Kansas is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you will join a team dedicated to improving the lives of the most vulnerable in our population. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of Kansas, and we will support you all the way.
The Licensed Registered Nurse (RN) Prior Authorization Supervisor will be responsible for overseeing the healthcare management staff including the organizing and developing high performing teams. Additionally, the Licensed RN Prior Authorization Supervisor will collaborate with area managers to ensure consistency in clinical interventions supporting out members. The Licensed RN Prior Authorization Supervisor will also be accountable for meeting the financial, operational, and quality objectives of the unit. This position has the potential to require up to 25% travel (in-state.)
Additional Responsibilities of the Licensed Registered Nurse (RN) Prior Authorization Supervisor:
Oversee the implementation of healthcare management services for assigned functional area.
Implement clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g. National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), state and federal standards and mandates as applicable).
Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution, and critical thinking.
Ensure the implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care.
Partake in the development and implementation of inter/intra-departments trainings.
Protect the confidentiality of member information and adhere to company policies regarding confidentiality.
Manage resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating and documenting of care.
Develop, initiate, monitor and communicate performance expectations as well as ensure the team's understanding and use of information system capability and functionality.
Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills.
Collaborate with others to identify and implement action plans that support the development of high performing teams.
Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance.
Consistently demonstrate the ability to serve as a model change agent and lead change efforts.
Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, as needed.
Works and provides coverage on weekends and holidays, as assigned.
Ability to work and provide coverage on weekends and holidays, as assigned.
Required Skills for the Licensed Registered Nurse (RN) Prior Authorization Supervisor:
3+ years of experience in a clinical setting.
1+ years of direct experience within prior authorization and/or precertification.
1+ years of supervisory, management or team lead experience, including recruitment/hiring of teams.
Previous managed care experience.
RN with active and unencumbered KS license.
Demonstrated computer literacy and advanced proficiency with Microsoft Excel, Word, and web-based applications and access databases.
Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.
Ability to work with people in such a manner as to build high morale and group commitment to goals and objective.
Preferred Skills for Licensed Registered Nurse (RN) Prior Authorization Supervisor:
Experience working with diverse teams and populations.
IDD (Intellectual or Developmental Disability) experience.
Experience with reporting: ability to understand and create reports with productivity and service metrics, and identify gaps.
Bachelor of Science in Nurse
Knowledge of community resources and provider networks.
The minimum level of education required for candidates in this position is an Associate's degree or equivalent experience.
Registered Nurse (RN) License for State of KS is required .
Functional - Medical Management/Medical Management - Precertification/1-3 Years
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years
Functional - Medical Management/Medical Management - Managed Care/Insurance Administration/1-3 Years
Functional - Management/Management - Multifunctional management: < 25 employees/1-3 Years
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/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 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.
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.