Aetna Licensed Prior Authorization Supervisor (CA MCD) in San Diego, California
Req ID: 45421BR
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.
As a Licensed Prior Authorization Supervisor, you will be responsible for oversight of healthcare management staff including the organization and development of high performing teams. Works closely with functional area managers to ensure consistency in clinical interventions supporting our members. Accountable for meeting the financial, operational and quality objectives of the unit.
Fundamental Components of the Licensed Prior Authorization Supervisor Included, but are not limited to:
Oversees the implementation of healthcare management services for assigned functional area Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g. NCQA, URAC, state and federal standards and mandates as applicable) Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care May act as a liaison with other key business areas. May develop/assist in development and/review new training content May collaborate/deliver inter and intra-departmental training sessions Protects the confidentiality of member information and adheres to company policies regarding confidentiality Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating and documenting of care Develop, initiate, monitor and communicate performance expectations Ensures the team's understanding and use of information system capability and functionality May have responsibility for their own case load work May act as a single point of contact for the customer and the Account Team including: participation in customer 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 Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance Consistently demonstrates the ability to serve as an model change agent and lead change efforts Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when needed.
One of the following active and unrestricted clinical licenses in the state of California required: Registered Nurse (RN) - strongly preferred; Licensed Clinical Social Worker (LCSW); Licensed Independent Social Worker (LISW); Licensed Professional Counselor (LPC) 3 - 5+ years of professional experience in clinical area of expertise1-3+ years of direct experience within prior authorization/precertification Ability to communicate effectively with Providers, Members, Staff and other Leaders both in oral and written formats. Ability to evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes. Ability to work with people in such a manner as to build high morale and group commitment to goals and objective.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
One of the following active and unrestricted clinical licenses in the state of California required: Registered Nurse (RN) - strongly preferred; Licensed Clinical Social Worker (LCSW); Licensed Independent Social Worker (LISW); Licensed Professional Counselor (LPC)
Functional - Medical Management/Medical Management - Precertification/1-3 Years
Functional - Clinical / Medical/Concurrent review / discharge planning/1-3 Years
Functional - Administration / Operations/Management: < 25 employees/1-3 Years
Functional - Clinical / Medical/Management: < 25 employees/1-3 Years
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/4-6 Years/End User
ADDITIONAL JOB INFORMATION
•Master's degree in behavioral health field; or •Registered Nurse (BSN preferred): and •Active unrestricted State Licensure in applicable functional area. (eg RN, LPC, LCSW) -1-3 years of UM/Prior Auth experience is preferred. •MCO experience is highly desired. •Minimum of 1-3 years supervisory or management experience. •Reporting: ability to understand and create reports with productivity and service metrics; identify gaps •Ability to communicate effectively with Providers, Members, Staff and other Leaders both in oral and written formats (e.g., may provide support to the sales staff & network staff via onsite customer visits and/or presentations) •Ability to evaluate and interpret data, to identify areas of improvement, and focus on interventions to improve outcomes. •Ability to work with people in such a manner as to build high morale and group commitment to goals and objectives. •Computer literacy and advanced proficiency with Microsoft Excel, Word, and web-based applications and access databases is required •Knowledge of community resources and provider networks •Experience working with diverse teams and populations •Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
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 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.
Job Function: Health Care