Description: Oversight and Management of Case Management team processes including the organization and development of high performing teams. #LT-TS1
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.
Accountable for the day-to-day management of the Case Management team for appropriate implementation and adherence with established practices, policies and procedures. 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 designated groups and participates in 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.
5+ years of Case Management Experience; Required
Supervisory Leadership Experience; Required
Registered Nurse License and BSN; Required
Ability to use Technology to Analyze Healthcare Data; Required
Master's degree; Preferred
CCM Certification; Preferred
Managed Care experience; Preferred
Medi-Cal Experience; Preferred
Experience using the Dynamo System; Preferred
Bilingual Language Fluency; Preferred
Additional Job Information: This position will be responsible for following policies and procedures and developing/mentoring the case management team to ensure standards are being met/followed and the team is developed and supported.This is a Medicaid health plan in California that serves 2 counties. This position is based in Sacramento and will collaborate closely with the San Diego Manager of Case Management.
Functional Skills: Administration / Operation - Management: < 25 employees, Clinical / Medical - Direct patient care (hospital, private practice), Clinical / Medical - Disease management
Education: Nursing - Registered Nurse (RN)
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.
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