Aetna VA MCD Sup, Prior Auth in Richmond, Virginia
Req ID: 51145BR
The Prior Authorization Supervisor will be responsible for overseeing the prior authorizations team which includes; coaching, mentoring, and developing of team members to achieve a high performance standard. This role is responsible for collaborating with other medical management supervisors and managers to ensure consistency in clinical interventions supporting our members and will also be accountable for meeting the financial, operational, and quality objectives.
-Responsibilities of the 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. NCQA, 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
Background Experience Desired:
Required Qualifications and Education of the Prior Authorization Supervisor: 3+ years of experience in a clinical setting, behavioral health experience desired 1+ years of direct experience within utilization management, prior authorization and/or precertification required 1+ years of supervisory or management experience required RN with active and unencumbered VA license required; Bachelor of Nursing (BSN) is preferred Previous managed care experience is required.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Licenses and Certifications:
Nursing/Registered Nurse (RN) is required
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4-6 Years
Functional - Medical Management/Medical Management - Precertification/1-3 Years
Functional - Medical Management/Medical Management - Clinical coverage and policies/1-3 Years
Functional - General Management/Multi-functional management: < 25 employees/1-3 Years
Functional - Clinical / Medical/Concurrent review / discharge planning/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:
Ability to work with people in such a manner as to build high morale and group commitment to goals and objective. Experience with reporting: ability to understand and create reports with productivity and service metrics; identify gaps.
Demonstrated computer literacy and advanced proficiency with Microsoft Excel, Word, and web-based applications and access databases is required. Knowledge of community resources and provider networks. Experience working with diverse teams and populations. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of Virginia is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you ll join a team dedicated to improving the lives of Virginia Medicaid members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of Virginia, and we will support you all the way.
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. 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. 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.
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