Manager of Utilization Management/Concurrent Review MCO

Aetna; Richmond (VA); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

401k

Tuition reimbursement

Licensure and certification reimbursement

Job summary

Aetna in Richmond, Virginia is seeking a Manager of Utilization Management to oversee clinical programs and improve healthcare standards. This key role requires strong leadership to manage teams and ensure effective healthcare delivery.

The ideal candidate will have a Bachelor’s degree, a valid RN license in Virginia, and a minimum of 5 years of clinical experience. The position offers growth opportunities within a Fortune 500 company, with telework options post-training.

Qualifications

• 5 years in clinical area of expertise.
• 1+ year previous leadership experience managing onsite and remote staff.
• Nursing/Registered Nurse (RN) license active in Virginia.

Responsibilities

• Reinforces clinical philosophy, programs, policies and procedures.
• Communicates strategic plan and ensures tactical implementation.
• Identifies opportunities for best practices and innovations.
• Manages financial, operational, and quality objectives.

Skills

Leadership

Clinical expertise

Data analysis

Communication

Change management

Education

Bachelor's degree or equivalent experience

Job description

Manager of Utilization Management/Concurrent Review MCO

• Full‑time

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. Excellent benefits package, including 401k, tuition, licensure and certification reimbursement. We promote healthy & wellness lifestyles and offer specialty programs here at Aetna.

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.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

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.

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.

Responsibilities

• 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 focus on interventions to improve outcomes.

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

• Medical Management / Medical Management - Hospital / 3 Years
• Management / Health Care Delivery / 3 Years
• 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 a part of a Fortune 500 company with the ability for professional growth.

All your information will be kept confidential according to EEO guidelines.