Aetna Manager Health Services Long Term Care in Orlando, Florida

Req ID: 55341BR

POSITION SUMMARY

Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.

Fundamental Components but not limited to the following:

Reinforce health services philosophy, programs, policies and procedures.

Ensure implementation of tactics to meet strategic direction for cost and quality outcomes.

Identify 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 teams for appropriate implementation and adherence with established practices, policies and procedures if there is not a supervisor position.

Work closely with functional area managers to ensure consistency in interventions supporting our plan sponsors.

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.

Assess developmental needs and collaborate with others to identify and implement action plans that support the development of high performing teams.

Consistently demonstrate the ability to serve as a model change agent and lead change efforts.

Accountable for maintaining compliance with policies and procedures and implement them at the employee level.

Ability to evaluate and interpret data, identify areas of improvement and focus on interventions to improve outcomes.

Develop guidelines for utilization of services and case staffing.

Provide prompt resolution regarding issues that may surface from agencies, providers, contracted facilities, members and their families.

Provide staff training and development. Determine policies and procedures that are needed to ensure staff activities meet regulatory requirements.

Prepare documentation for audits.

Collaborate with licensed staff from other areas that assist with oversight of clinical staff and activities of licensed personnel.

Develop guidelines for utilization of services and case staffing.

BACKGROUND/EXPERIENCE:

4+ years of experience in managed care

1+ years management experience

3+ years of experience in a physical or behavioral healthcare setting

Knowledge of the regulations, standards, and policies which relate to medical management in Florida, LTSS (Long term Care) services and Medicaid Services (a plus)

2+ years of clinician experience preferred (Social Worker, Nurse, Healthcare Audit)

EDUCATION

The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

FUNCTIONAL EXPERIENCES

Functional - Administration / Operations/Management: < 25 employees/1-3 Years

Functional - General Management/Multi-functional management: < 25 employees/4-6 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Adobe Acrobat Suite v5/4-6 Years/End User

Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User

Technical - Desktop Tools/Microsoft PowerPoint/4-6 Years/End User

Technical - Desktop Tools/Microsoft SharePoint/4-6 Years/End User

ADDITIONAL JOB INFORMATION

Contract compliance is key.

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. Click here to review the benefits associated with this position.

Aetna takes our candidates'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.

Job Function: Health Care

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.