**Experienced Manager of Utilization Management/Concurrent Review MCO – Healthcare Leadership Position with Remote Work Options**

About the Opportunity

Are you a seasoned healthcare professional with a passion for leadership and a commitment to delivering high-quality, cost-effective care? Do you have a strong background in utilization management and concurrent review, with a proven track record of driving business results and improving outcomes? If so, we invite you to consider this exciting opportunity to join our team as a Manager of Utilization Management/Concurrent Review MCO.

About Our Company

At Aetna, we're dedicated to shaping the future of healthcare and improving the lives of our members. As a Fortune 500 company, we offer a dynamic and supportive work environment that values growth, achievement, and diversity. Our team is passionate about making a difference, and we're committed to excellence in everything we do.

Job Description

As a Manager of Utilization Management/Concurrent Review MCO, you'll play a critical role in driving the delivery of high-quality, cost-effective products and services to our members. You'll be responsible for reinforcing our clinical philosophy, programs, policies, and procedures, and for communicating strategic plans and specific tactics to meet our business objectives. You'll also be accountable for meeting financial, operational, and quality objectives, and for developing and implementing business cases for change.

Key Responsibilities

* Reinforce clinical philosophy, programs, policies, and procedures * Communicate strategic plan and specific tactics to meet plan * Ensure implementation of tactics to meet strategic direction for cost and quality outcomes * Create direction and communicate a business case for change by focusing on and addressing key priorities to achieve business results * Identify 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 * Work 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, participating 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 * Assess developmental needs and collaborate with others to identify and implement action plans that support the development of high-performing teams * Consistently demonstrate 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

Qualifications

* 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 * Bachelor's degree or equivalent experience * Nursing/Registered Nurse (RN) is required, active and unrestricted for the state of Virginia or compact including state of VA

Skills and Competencies

* Strong leadership and management skills, with the ability to motivate and inspire teams * Excellent communication and interpersonal skills, with the ability to build strong relationships with colleagues, customers, and stakeholders * Strong analytical and problem-solving skills, with the ability to evaluate and interpret data and identify areas for improvement * Ability to work in a fast-paced environment and prioritize multiple tasks and responsibilities * Strong business acumen, with the ability to understand and analyze financial and operational data * Ability to lead change efforts and implement business cases for change * Strong knowledge of clinical philosophy, programs, policies, and procedures * Ability to maintain compliance with policies and procedures and implement them at the employee level

Career Growth Opportunities and Learning Benefits

As a Manager of Utilization Management/Concurrent Review MCO, you'll have the opportunity to grow and develop your skills and knowledge in a dynamic and supportive work environment. You'll have access to a range of training and development programs, including leadership development, clinical education, and business skills training. You'll also have the opportunity to work with a talented and experienced team of healthcare professionals who are passionate about making a difference.

Work Environment and Company Culture

As a remote worker, you'll have the flexibility to work from home and enjoy a better work-life balance. You'll also have access to a range of benefits and perks, including a competitive salary, comprehensive health insurance, and a 401(k) plan. Our company culture values growth, achievement, and diversity, and we're committed to creating a workplace where everyone feels valued and supported.

Compensation, Perks, and Benefits

As a Manager of Utilization Management/Concurrent Review MCO, you'll receive a competitive salary and a range of benefits and perks, including: * Comprehensive health insurance * 401(k) plan * Flexible work arrangements, including remote work options * Opportunities for professional growth and development * A dynamic and supportive work environment * A range of benefits and perks, including tuition reimbursement, licensure and certification reimbursement, and specialty programs

How to Apply

If you're a seasoned healthcare professional with a passion for leadership and a commitment to delivering high-quality, cost-effective care, we invite you to apply for this exciting opportunity. Please submit your resume and a cover letter outlining your qualifications and experience. We look forward to hearing from you! Apply To This Job Apply for this job