Aetna VA MCD UM Supervisor, CHS in Richmond, Virginia
Req ID: 52109BR
The UM Supervisor will be responsible for overseeing the UM department staff including the organizing and developing high performing teams; will collaborate with other medical management supervisors/managers to ensure consistency in clinical interventions supporting our members; and will also be accountable for meeting the financial, operational, and quality objectives
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
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 is desired
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4-6 Years
Functional - Medical Management/Medical Management - Clinical coverage and policies/1-3 Years
Functional - General Management/Multi-functional 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/4-6 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.
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.
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Job Function: Health Care