Description: This role is office based in Dallas, TX.
Standard business hours Monday-Friday are required.
Oversight and Management of clinical team processes including the organization and development of high performing teams.
Fundamental Components: - Reinforces clinical philosophy, programs, policies and procedures. - Communicates strategic plan and specific tactics to meet plan. - Ensures implementation of tactics to meet strategic direction for cost and quality outcomes. - Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results. - Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes. - Accountable for meeting the financial, operational and quality objectives of the unit. - May be accountable for the day-to-day management of teams for appropriate implementation and adherence with established practices, policies and procedures if there is not supervisor position - Works closely with functional area managers to ensure consistency in clinical interventions supporting our plan sponsors. - Develop, initiate, monitor and communicate performance expectations. - May act as a single point of contact for the customer and the Account Team which includes participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers. - 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. - Consistently demonstrates the ability to serve as a model change agent and lead change efforts. - Accountable for maintaining compliance with policies and procedures and implements them at the employee level. - Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes. Background Experience: - 5+ years in clinical area of expertise required - 5+ years of concurrent review or prior authorization experience is required - 2+ years of supervisory experience is required - Active unrestricted State Licensure in applicable functional area is required (eg RN, LPC, LCSW) - Master's degree in behavioral health field; or Registered Nurse required (BSN preferred) Additional Job Information: Responsible for the day to day oversight of all utilization management job responsibilities and reporting. This is an office based position. Required Skills: Benefits Management - Interacting with Medical Professionals, Benefits Management - Supporting Medical Practice, Benefits Management - Understanding Clinical Impacts, General Business - Maximizing Work Practices, Leadership - Collaborating for Results, Leadership - Driving a Culture of Compliance Desired Skills: Benefits Management - Maximizing Healthcare Quality, Leadership - Developing and Executing Strategy Functional Skills: Clinical / Medical - Clinical claim review & coding, Clinical / Medical - Concurrent review / discharge planning, Clinical / Medical - Precertification, Clinical / Medical - Quality management Technology Experience: Aetna Application - Access HR, Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel Education: Nursing - Registered Nurse Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by 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.