Job Description
ABOUT OUR COMPANY
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.
POSITION SUMMARY
The 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.
ADDITIONAL JOB INFORMATION
This positions will support the National Accounts Dedicated Unit in Richfield, Ohio for Precertification/UM/CM for a dedicated Plan Sponsor.
Hours of operation are Mon-Friday from 8 am-6 pm, standard 40 hour work week.
Job Requirements
EDUCATION
Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Registered Nurse (RN) is required
Certified Case Manager is desired
Certified Utilization Review (CPUR) is desired
FUNCTIONAL WORK EXPERIENCE
Medical Management - Administration/Management
Concurrent Review/discharge planning
Precertification
Case Management
Management Operations
Managed Care
REQUIRED SKILLS
Adapt coaching style to effectively support individuals different from self
Adjusts communication methods effectively to remote workforce
Assess and manage volume of work against planned resources
Engaging and Developing People
Deal decisively with performance problems
Extract and manipulate data from appropriate systems to meet business performance reporting needs
Must be knowledgeable with Microsoft Word, Excel, and PowerPoint
DESIRED SKILLS
Aetna Strategic Desktop
Analyze and research requests for member PHI in accordance with HIPAA Call Handling procedures
Create diverse work teams
Implement strategies to manage medical cost issues
Modify communication styles to effectively communicate with diverse audiences
Understanding Clinical Impacts
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with Aetna.
We conduct pre-employment drug and background testing.
Aetna does not permit the use of tobacco related products or drugs in the workplace. No agencies, please.
Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V
Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna's Affirmative Action responsibilities extend to women, minorities, persons with disabilities and veterans. Company policy also provides for equal opportunity for qualified individuals regardless of race, color, sex, national origin, religion, age, disability, veteran status, sexual orientation, gender identity or marital status.
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