This Management position is an opportunity to get in on the ground floor of a new and rapidly growing Medicaid Health Plan. Looking for a high-energy professional to provide leadership and support for the CM Team, composed of nurses and case management assistants, who are dedicated to caring for our members. Position reports to the Vice President for Medical Management, and is a vital link in the Plan for member support.Partners with the UM Manager and is an important member of the Operations team to ensure smooth functioning of Medical Management Function. Excellent opportunity to participate in innovative case management and population health initiatives.
Management of Care Management Program in a high volume environment servicing Medicaid population. Will include oversight of clinical and non clinical staff.
Will provide daily operational oversight, management and leadership for Case Management Services that focus on intensive and supportive services to members across the continuum of care.
Will have knowledge of community resources, care transitions, population health and social determinants of care
Will have experience with aggregating and interpreting data to measure health outcomes.
Will serve as liaison between Case Management and Plan operations.
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.
BACKGROUND/EXPERIENCE desired: Registered Nurse (RN) is required 5+ years in clinical area of expertise is required 2+ years of supervisory or leadership experience is required 5+ years of case management experience is required 2+ years of Medicaid experience is required
Managed Care experience is strongly preferred Utilization Management experience is preferred Previous experience using Dynamo system is a plus Certified Case Manager (CCM) is preferred
EDUCATION The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS Nursing/Registered Nurse is required
TELEWORK SPECIFICATIONS For current Aetna employees, telework will be available for 2 days during the week; 3 days in office is required For any external candidate, telework potential will be evaluated after 90 day orientation period
FUNCTIONAL EXPERIENCES Functional - Management/Management - Health Care Delivery/2+ Years Functional - Nursing/Case Management/5+ Years
ADDITIONAL JOB INFORMATION 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 health care. What we do will benefit generations to come.
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.
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. #LI-KK1
Aetna's mission is to build a healthier world by helping people realize their ambitions and achieve their goals, one person and one community at a time. We are a leading diversified health care benefits company that is helping to transform health care by providing and advancing the information, tools and resources people need to achieve their best possible health.
Our team of nearly 50,000 employees serves an estimated 37 million people and is committed to giving them a better health care experience while providing access to affordable, high-quality health care. Our digital tools and online resources help guide members on their health care journey. And our people are empowered, innovative and supported at every step of their own career journey. Our strength as a company enables us to deliver greater value and well-being opportunities to consumers, and bigger challenges, rewards and career opportunities for our employees. Join us and help turn health ambitions into achievements - big and small.