Manager, Clinical Health Services

Aetna - Morris County, NJ3.8

This is a work at home opportunity, but only candidates that reside in NJ will be considered.

The Manager for Clinical Health Services - Care Management is responsible for oversight and management of clinical team processes including the organization and development of high performing teams. The Manager provides direct supervision to a team of Supervisors who oversee teams of Care Managers located across the state of New Jersey. The program serves high risk commercial and Medicare Advantage members in a new innovative community-based program. The Manager provides leadership and oversight of productivity and quality performance to optimize member well-being, while driving clinical and cost-effective outcomes.

Fundamental Components:
Reinforces clinical philosophy, program processes, policies and procedures.
Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business success.
Identifies opportunities to improve outcomes at the individual member level and the organizational level.
Consistently demonstrates the ability to serve as a model change agent and lead change efforts across the team.
Provides direct supervision and guidance to community-based employees focused on delivering long-term, impactful care management to Medicare and Commercial membership.
Prepares, analyzes and applies pertinent data, metrics and reports to monitor and enhance quality, productivity, and assure adherence to policy and procedures.
Contributes to associates on-boarding, coaching and ongoing education to build individual and team competencies and performance.
Responsible for the teams administrative oversight, i.e. team meetings, time and attendance, caseload balance and associate performance.
Ability to manage a mixed work environment, overseeing both work-at-home and potentially office-based team members.
Conducts individual and team quality reviews/audits as required, including home visit ride along sessions, monitoring associate performance and adherence to documentation procedures.
Provides clinical guidance and serves as an expert resource to the care team and assists with member care management case reviews and consultations.
Participates in the clinical leadership team to promote continuous quality improvement and actively contributes to care team best practice standards and strategies.
Deliberately facilitates team building and inter-disciplinary collaboration.
Provides clinical expertise and business direction to drive the effective execution of care team services through best practices in nursing and care management
Adheres to care management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Maintains a comprehensive working knowledge of managed care, benefits and services for target population to maximize member and program outcomes.
Other responsibilities as required.

5+ years clinical experience required
2+ years supervisory experience preferred, preferably in a managed care environment with a focus on case management
3+ years case management experience required
2+ years of home care or hospice care preferred
Managed Care, Medicare/Medicaid experience required
Local travel is required and occasional state and/or national travel also required
Ability to work flexible hours
2+ years providing field care management services as part of an interdisciplinary care team desired
Understanding of a local, community based, care management model, delivered both in person and telephonically
Excellent written/verbal communication skills; background in motivational interviewing desired
Strong organizational & critical thinking skills
Ability to build relationships and work collaboratively within an inter-disciplinary team model
Bilingual (Spanish) preferred

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

The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience. A Masters degree is preferred.
Active, unrestricted State Licensure as a Registered Nurse is required
Certified Managed Care Nurse (CMCN) or CCM preferred

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.

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.