At Aetna Better Health of Texas, we are committed to helping people on their
path to better health. By taking a total and connected approach to health, we
guide and support our members so they can get more out of life, every day. We
are looking for people like you who value excellence, integrity, caring and
innovation. As an employee, you’ll join a team dedicated to improving the
lives of Texas STAR Kids members. We value diversity and are dedicated to
helping you achieve your career goals.
This role is office based in Dallas, TX with 10-25% of field based travel
The Supervisor is responsible for oversight of service coordination 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. This position is office based
with routine travel to meet with field based staff, as needed.Use of personal
vehicle when traveling in the field; must have active and valid TX driver’s
license, reliable transportation and vehicle insurance. Business mileage is
eligible for reimbursement, in accordance with travel policy guidelines.
* 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)
* Serves as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking
* Ensures 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
* Develops, initiates, monitors and communicates 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
* Participates 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
* Establishes 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
* Creates a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when needed
* Accountable for maintaining compliance with policies and procedures and implements them at the employee level.
* 3+ years in clinical area of expertise required.
* Minimum of 1 year previous service coordination or case management experience and experience with pediatric clients is required.
* Health plan or MCO experience is required.
* Registered Nurse (BSN preferred), OR Master’s degree in behavioral health field AND active unrestricted State Licensure in applicable functional area required. (eg RN, LCSW, LPC, LMSW)
* RN RUG certified; or ability to complete RUG certification within 60 days of start date is required
* Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
* Integrated care model experience is preferred.
* Ability to work with people in such a manner as to build high morale and group commitment to goals and objectives.
* Ability to evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes.
* 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).
* Previous supervisory or leadership experience.
Potential Telework Position:
Percent of Travel Required:
10 – 25%
Aetna is an Equal Opportunity, Affirmative Action Employer
Benefit eligibility may vary by position.
Candidate Privacy Information:
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.