Job Overview
Company:
Location:
Base Pay:
 $64,620 - $78,100 /Year
Other Pay:
Employee Type:
 Full-Time
Industry:
 Healthcare - Health Services
Insurance
Manufacturing
Manages Others:
 Yes
Job Type:
 Health Care
Insurance
Nurse
Req'd Education:
 4 Year Degree
Req'd Experience:
 At least 5 year(s)
Req'd Travel:
 Negligible
Relocation Covered:
 No
Reference ID:
27745002_310591033
 
  
Contact:
Not Available
Phone:
Not Available
Email:
Send Email Now
Fax:
Not Available
 

company overview

Aetna is one of the nation’s leading diversified health care benefits companies, serving members with information and resources to help them make better informed decisions about their health care.

Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life, long-term care and disability plans and medical management capabilities. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans and government-sponsored plans.

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Care Mgmt Nurse Supervisor - 28952    
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job description

ABOUT OUR COMPANY
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.


POSITION SUMMARY
The Supervisor is responsible for management of medical services staff including the organization and development of high performing teams. Works closely with managers (re: Case/Disease Management) ensuring consistency in care management interventions across membership. Facilitates effective interfaces among team members, as well as across teams, providers and Aetna departments. Responsible for the day-to-day implementation of Aetna's medical management services policies and procedures. Accountable for meeting the financial, operational and quality objectives of the unit.

ADDITIONAL JOB INFORMATION
This positions will support the National Accounts Dedicated Unit in Richfield, Ohio for Precertification/UM/CM for a dedicated Plan Sponsor.
Hours of operation are Mon-Friday from 8 am-6 pm, standard 40 hour work week.


job Requirements

EDUCATION 
  • Bachelor's degree or equivalent experience.

    LICENSES AND CERTIFICATIONS
  • Registered Nurse (RN) is required
  • Certified Case Manager is desired
  • Certified Utilization Review (CPUR) is desired

    FUNCTIONAL WORK EXPERIENCE
  • Medical Management - Administration/Management
  • Concurrent Review/discharge planning
  • Precertification
  • Case Management
  • Management Operations
  • Managed Care

    REQUIRED SKILLS
  • Adapt coaching style to effectively support individuals different from self
  • Adjusts communication methods effectively to remote workforce
  • Assess and manage volume of work against planned resources
  • Engaging and Developing People
  • Deal decisively with performance problems
  • Extract and manipulate data from appropriate systems to meet business performance reporting needs
  • Must be knowledgeable with Microsoft Word, Excel, and PowerPoint
    DESIRED SKILLS
  • Aetna Strategic Desktop
  • Analyze and research requests for member PHI in accordance with HIPAA Call Handling procedures
  • Create diverse work teams
  • Implement strategies to manage medical cost issues
  • Modify communication styles to effectively communicate with diverse audiences
  • Understanding Clinical Impacts

    We value leadership, creativity and initiative.  If you share those values and a commitment to excellence and innovation, consider a career with Aetna.

    We conduct pre-employment drug and background testing.
    Aetna does not permit the use of tobacco related products or drugs in the workplace. No agencies, please.
     
    Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V

    Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna's Affirmative Action responsibilities extend to women, minorities, persons with disabilities and veterans. Company policy also provides for equal opportunity for qualified individuals regardless of race, color, sex, national origin, religion, age, disability, veteran status, sexual orientation, gender identity or marital status.

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