Sep 15, 2019

Next Best Action Supervisor

  • Professional Diversity Network
  • Harrisburg, PA, USA
Full-Time Other

Job Description


  • Responsible for the oversight of healthcare management staff including the organization and development of high performing teams.
  • Works closely with functional area managers to ensure consistency in health related and psycho-social interventions supporting our members and is accountable for meeting the financial, operational and quality objectives of the unit.


Fundamental Components:
  • Oversee the implementation of healthcare management services for assigned functional area. Accountable for maintaining policies & procedures in accordance with applicable regulatory and accreditation standards and implementing them at the employee level (e.g. NCQA, URAC, state and federal standards and mandates as applicable).
  • 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.
  • Manage resources responsible for improved health care decision making, enhancement of member impact, and leveraging technology.
  • May have responsibility for member escalation cases.
  • May act as a single point of contact for the customer and the Account Team including: participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.
  • Assess 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 demonstrate the ability to serve as a model change agent and lead change efforts.
  • Collaborate with licensed staff from other areas that assist with oversight of clinical staff and activities of licensed personnel. Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking.
Background Experience:
  • 2 years leading claims/customer service team.
  • Experience with claims/call center environment.
  • Bachelor's degree required.
Potential Telework Position: No Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: 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.





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