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RN, Mgr, Pre Authorization
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | los angeles, California |
About this job
$5000 Sign on Bonus! We are seeking an experienced RN with managed care, leadership, and prior authorization expertise.
**some relocation assistance is offered**.
Candidate does need to have managed care experience, prior auth experience and supervisory experience. UR experience is acceptable as there may be overlap between Prior Auth and UR
Aetna Better Health Premier Plan, a MI Health Link Plan, is looking for caring people who share our vision of helping to provide innovative, community-based health care for dual-eligible Medicare-Medicaid members in Michigan. Aetna Better Health of Michigan is a great place to work. As an employee, not only will you be helping others, youll be part of a team just as dedicated as you. Our company values diversity and is dedicated to helping you achieve your career goals.
POSITION SUMMARY:
The Manager of Prior Authorizations provides oversight and management of the Prior Authorizations clinical team processes including the organization and development of high performing PA teams.
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. May be accountable for the day-to-day management of teams for appropriate implementation and adherence with established practices, policies and procedures if there is not supervisor position 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 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. 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.
BACKGROUND/EXPERIENCE
Candidate does need to have managed care experience, prior auth experience and supervisory experience. UR experience is acceptable as there may be overlap between Prior Auth and UR
:
5-7 years in clinical area of expertise and previous experience managing a clinical team(s). Registered Nurse (BSN preferred): and Active unrestricted State Licensure in applicable functional area. (eg RN, LPC)
EDUCATION: The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS:
Nursing/Registered Nurse
TECHNOLOGY EXPERIENCES:
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/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
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.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Employment Type Regular Career Band Description Management
**some relocation assistance is offered**.
Candidate does need to have managed care experience, prior auth experience and supervisory experience. UR experience is acceptable as there may be overlap between Prior Auth and UR
Aetna Better Health Premier Plan, a MI Health Link Plan, is looking for caring people who share our vision of helping to provide innovative, community-based health care for dual-eligible Medicare-Medicaid members in Michigan. Aetna Better Health of Michigan is a great place to work. As an employee, not only will you be helping others, youll be part of a team just as dedicated as you. Our company values diversity and is dedicated to helping you achieve your career goals.
POSITION SUMMARY:
The Manager of Prior Authorizations provides oversight and management of the Prior Authorizations clinical team processes including the organization and development of high performing PA teams.
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. May be accountable for the day-to-day management of teams for appropriate implementation and adherence with established practices, policies and procedures if there is not supervisor position 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 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. 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.
BACKGROUND/EXPERIENCE
Candidate does need to have managed care experience, prior auth experience and supervisory experience. UR experience is acceptable as there may be overlap between Prior Auth and UR
:
5-7 years in clinical area of expertise and previous experience managing a clinical team(s). Registered Nurse (BSN preferred): and Active unrestricted State Licensure in applicable functional area. (eg RN, LPC)
EDUCATION: The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS:
Nursing/Registered Nurse
TECHNOLOGY EXPERIENCES:
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/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
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.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Employment Type Regular Career Band Description Management