Aetna, a CVS Health Company
This position will be working from home, but will require the employee to be licensed and located within PA, WV, NC, GA, LA, AL, FL, TX, OH, MS, KS, IA, NE, MS, KY, MI, NY, CT, ME, CA, or NV
Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.
The Training & Quality Clinician will support the training and compliance monitoring of the DSNP Care Management team. They are responsible for conducting audits of current processes, reports, and procedures to identify process improvements and issue resolutions.
Develops and conducts ongoing staff training based on workflow needs and outcomes of clinical audits.
Develops and implements comprehensive training program for department new hires.
Implements training programs to increase role specific consistencies and efficiencies related to process workflows.
Measures outcomes of clinical staff training and identifies key findings to ensure effective alignment of training content and method of delivery with business objectives and staff performance requirements.
Provides ongoing and random qualitative and quantitative analysis using organizational performance measurements to ensure compliance with government regulations and corporate policy.
Tracks and trends audit results, providing feedback to management.
Recommends corrective action and facilitates the implementation of remedial and process improvement plans.
Excellent verbal and written communication skills.
Experience in designing, developing, and delivering training programs
Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
Ability to use standard corporate software packages and corporate applications.
3 – 5 years of experience in a managed care clinical operation environment (utilization management, case management, and/or behavioral health case management) required.
Strong data analysis and report preparation skills.
Education And Certification Requirements
A current clinical license is required based on the clinical sector supported (e.g., RN, LCSW, LSW ) .
Clinical Licensure Required
Primary Location (City, State)
Potential Telework Position
Percent Of Travel Required
0 – 10%
Full or Part Time
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.