Aetna Clinical Supervisor, Care Management in Lancaster, Pennsylvania
Req ID: 51999BR
We are building an exciting new clinical and member experience program at Aetna. Aetna Community Care is a member centric, team-delivered, community based care management model that joins members where they are.
The Clinical Supervisor, Care Management is responsible for business, clinical and operational performance and oversees the direct supervision, guidance and job performance of a group of Care Managers. The team serves high risk commercial and Medicare Advantage members in a new innovative community based program. This position provides leadership and oversight of productivity and quality performance to optimize member well-being, clinical and cost effective outcomes.
Provides direct supervision and guidance to a team of RN Care Managers. Teams are remote based throughout the State of Pennsylvania.
Prepares, analyzes and applies pertinent data, metrics and reports to monitor and enhance quality, productivity, and assure adherence to policy and procedures
Contributes to associates on-boarding, coaching and ongoing education to build individual and team competencies and performance Responsible for the teams administrative oversight, i.e. team meetings, time and attendance, caseload balance and associate performance
Ability to manage a remote a team and/or an office based team
Conducts individual and team quality reviews/audits as required, including home visit ride alongs, monitoring associate performance and adherence to documentation procedures
Provides clinical guidance and serves as an expert resource to the care team and assists with member care management case reviews and consultations
Participates in the clinical leadership team to promote continuous quality improvement and actively contributes to care team best practice standards and strategies
Deliberately facilitates team building and inter-disciplinary collaboration
Provides clinical expertise and business direction to drive the effective execution of care team services through best practices
Adheres to care management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
Maintains a comprehensive working knowledge of managed care, benefits and services for target population to maximize member and program outcomes
Other responsibilities as required.
5+ years clinical experience required
2+ years supervisory experience required, preferably in a managed care environment
Managed Care, Medicare/Medicaid experience required
Local travel is required and occasional regional travel also required
Ability to work flex hours
5+ years Care Management experience preferred
2+ years providing field care management services as part of an interdisciplinary care team desired
Understanding of a local, community based, care management model, delivered both in person and telephonically Excellent written/verbal communication skills; background in motivational interviewing desired
Strong organizational & critical thinking skills
Experience in managing a remote based team Ability to build relationships and work collaboratively within an inter-disciplinary team model
Bilingual (Spanish) preferred.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Responsible for the oversight of teams located the Harrisburg area to include the following counties: Lancaster, Lebanon, York, Adams, Franklin, Cumberland, Perry and Dauphin, PA.
Additional Job Information:
The minimum level of education required for candidates in this position is a bachelors degree (BSN) in public health or other relevant discipline preferred.
Active clinical license (RN), active and in good standing.
Certified Managed Care Nurse (CMSN) or CCM preferred.
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. 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.
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