Job Description
Job Description
This role is open to Telework from anywhere but candidate must have IL state licensure!
Help us elevate our patient care to a whole new level!
Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members health care and social determinant needs. Join us in this exciting opportunity as we grow and expand dually eligible members to change lives in new markets across the country.
Position Summary:
The Supervisor, Clinical Health Service will oversee the implementation of healthcare management services for assigned functional area.
Fundamental Components
* Implements 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 implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care
* May act as a liaison with other key business areas.
* May develop/assist in development and/review new training content
* May collaborate/deliver inter and intra-departmental training sessions
* Protects the confidentiality of member information and adheres to company policies regarding confidentiality
* Manages 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
* Evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes
* Develop, initiate, evaluate, monitor, and communicate performance expectations
* Ensures 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
* Assesses developmental needs and collaborates 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 demonstrates 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, when needed Accountable for maintaining compliance with policies and procedures and implements them at the employee level
* Communicate effectively with Providers, Members, Staff and other Leaders (e.g., may provide support to the sales staff & network staff via onsite customer visits and/or presentations)
Required Qualifications
-3 - 5+ years in clinical area of expertise
-Unrestricted RN or Masters level BH licensure
-Must have IL state licensure
-Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
Preferred Qualifications
-Managed Care experience
-Supervisor experience
-Managed Medicare experience
Education
-Registered Nurse (BSN preferred, Associates required)
-Masters level BH degree (LCSW, LCPC)
-Active unrestricted State Licensure in applicable functional area. (e.g., RN)
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
This role is open to Telework from anywhere but candidate must have IL state licensure!
Help us elevate our patient care to a whole new level!
Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members health care and social determinant needs. Join us in this exciting opportunity as we grow and expand dually eligible members to change lives in new markets across the country.
Position Summary:
The Supervisor, Clinical Health Service will oversee the implementation of healthcare management services for assigned functional area.
Fundamental Components
* Implements 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 implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care
* May act as a liaison with other key business areas.
* May develop/assist in development and/review new training content
* May collaborate/deliver inter and intra-departmental training sessions
* Protects the confidentiality of member information and adheres to company policies regarding confidentiality
* Manages 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
* Evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes
* Develop, initiate, evaluate, monitor, and communicate performance expectations
* Ensures 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
* Assesses developmental needs and collaborates 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 demonstrates 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, when needed Accountable for maintaining compliance with policies and procedures and implements them at the employee level
* Communicate effectively with Providers, Members, Staff and other Leaders (e.g., may provide support to the sales staff & network staff via onsite customer visits and/or presentations)
Required Qualifications
-3 - 5+ years in clinical area of expertise
-Unrestricted RN or Masters level BH licensure
-Must have IL state licensure
-Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
Preferred Qualifications
-Managed Care experience
-Supervisor experience
-Managed Medicare experience
Education
-Registered Nurse (BSN preferred, Associates required)
-Masters level BH degree (LCSW, LCPC)
-Active unrestricted State Licensure in applicable functional area. (e.g., RN)
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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