Aetna Registered Nurse (RN) VP/Director Medical Management - KS MCD - 51631BR in Overland Park, Kansas

Req ID: 51631BR

Are you ready to join a company that is changing the face of health care across the nation? 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 KanCare members. 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.

POSITION SUMMARY

This position oversees the implementation and on-going execution of the strategic and operational business plan for the business segment's clinical operations, inbound/outbound call queue, implementation, and/or plan sponsor operations. Coordinates business segment policies and procedures in support of financial, operational and service requirements. Offices in Overland Park and Topeka. The position will require the ability to travel, approximately 25-50%, mostly in-state and to corporate Medicaid offices in Phoenix, AZ Qualified candidates must have experience working in the KS market: familiarity with and knowledge of local geography and demographics; KanCare program, membership and waivers; and local networks and providers.

Fundamental Components:

  • Develop and manage clinical operations focused on improving clinical and financial outcomes, member engagement, and satisfaction.

    • Serve as liaison with regulatory and accrediting agencies and other health business units.

    • Formulate and implement strategy for achieving applicable department/unit metrics and provide operational direction.

    • Serve as technical, professional and business resource (may cross multiple business functions).

    • Develop and participate in presentations and consultations to existing and prospective customers.

    • Direct/provide enhancements to business processes, policies and infrastructure to improve operational efficiency (may cross multiple business functions).

    • Participates in internal and external health industry development efforts.

    • Develop, implement, and evaluate policies and procedures, which meet business needs (may cross multiple business functions).

  • Implements and monitors business plan and oversees any implementations or business transitions affecting service operations.

    • Collaborates and partners with other business areas across/within regions or segments and within other centralized corporate areas to ensure all workflow processes and inter-dependencies are identified and addressed on an on-going basis.

    • Promote a clear vision aligned with company values and direction; sets specific challenging and achievable objectives and action plans; motivates others to balance customer needs and business success; challenges self and others to look to the future to create quality products, services, and solutions.

Qualification Requirements:

  • Minimum of 8-10 years clinical leadership experience required.

  • Minimum of 5-10 years of managed care experience required.

  • Registered Nurse (RN) License for State of KS required.

    • Ability to synthesize program performance and clinical outcomes required.

    • Demonstrated management experience selecting, motivating and leading teams; mentoring and coaching staff required.

    • Exceptional communication skills - verbal, written and presentation - required.

-Experience working with the I/DD (Intellectual and Developmental Disabilities) population, strongly preferred

  • Proficiency with PC, MS Office Suite, applications and strong keyboard navigation skills required.

Education:

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

Licenses & Certifications:

  • Registered Nurse (RN) License is required.

FUNCTIONAL EXPERIENCES

Functional - Medical Management/Medical Management - Administration/Management/7-10 Years

Functional - Medical Management/Medical Management - Case Management/7-10 Years

Functional - Medical Management/Medical Management - Concurrent Review/7-10 Years

Functional - Medical Management/Medical Management - Managed Care/Insurance Clinical Staff/7-10 Years

Functional - Medical Management/Medical Management - Clinical coverage and policies/7-10 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/TE Microsoft Excel/7-10 Years/End User

Technical - Desktop Tools/Microsoft Word/7-10 Years/End User

Technical - Desktop Tools/Microsoft Outlook/7-10 Years/End User

Technical - Desktop Tools/Microsoft SharePoint/7-10 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.

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Job Function: Health Care