Manager of Utilization Management/Concurrent Review MCO

CVS Health

• $90K — $110K *
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • 5+ years in clinical area of expertise
  • 1+ year leadership experience managing onsite and remote teams (up to 12 direct reports)
  • Call Center experience is preferred
  • Utilization Manager experience is preferred
  • Previous Managed Care experience is preferred
  • Bachelor's degree or equivalent experience
  • Active and unrestricted RN license for Virginia or compact state

Responsibilities

  • Reinforce clinical programs, policies, and procedures
  • Communicate strategic plans and implement tactics for cost and quality
  • Identify opportunities for best practices and innovative approaches
  • Ensure financial, operational, and quality objectives are met
  • Manage day-to-day team operations in the absence of a supervisor
  • Act as a liaison between customers and Account Teams
  • Participate in recruitment and hiring processes for staff

Benefits

  • Standard business hours with no holidays or nights
  • Opportunity for professional growth within a Fortune 500 company
  • Encouraged to telework once fully trained and competent
Full Job Description
POSITION SUMMARY The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge. Standard business hours and no holidays nor nights. Fundamental Components but not limited to the following: 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. Qualifications BACKGROUND/EXPERIENCE: 5 years in clinical area of expertise 1+ year previous leadership experience (management of onsite and remote staff up to 12 direct reports and oversight up to 50) Call Center experience preferred Utilization Manager experience preferred Previous Managed Care experience preferred EDUCATION The minimum level of education for candidates in this position is a Bachelor's degree or equivalent experience. LICENSES AND CERTIFICATIONS Nursing/Registered Nurse (RN) is required, active and unrestricted for the state of Virginia or compact including state of VA. FUNCTIONAL EXPERIENCES Functional - Medical Management/Medical Management - Hospital/3 Years Functional - Management/Management - Health Care Delivery/3 Years Functional - Clinical / Medical/Precertification/3 Years Telework Specifications: Telework would be an option once a week once fully trained and competent in the role ADDITIONAL JOB INFORMATION Become apart of a Fortune 500 company with the ability for professional growth

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