Senior Clinical Program Consultant

Job Description

Excellent opportunity for an experienced clinician with a passion for consulting and improving overall population health to leverage clinical, analytic and consultative skills to join our team of Clinical Program Consultants (CPC) who offer clinical insights and solutions to help improve health plan performance for our group commercial plan sponsors. This is a clinical transformation-type role to support clients with ACO-like needs; experience with joint ventures, provider collaboration, or Accountable Care organizations required. Highly collaborative, individual contributor position in a professional environment working with the account team, customer and ACO, Aetna’s clinical operation teams and our Plan Sponsor Insights team of consultants. The CPC will support one or more customers in the healthcare industry vertical with a focus on helping ensure patients receive the right care at the right time and advancing member health – working directly with customers’ benefits teams.
Clinical Program Consultants are key members of Aetna’s Plan Sponsor Insights (PSI) business – a business focused on providing data-driven insights and solutions based on analytics to customers in the group commercial business. The work environment supports and thrives on out-of-the box thinking, creative talent and a consultative approach. Our team is highly valued by our internal partners as well as the customers we serve.

Key components of the role include advanced analytic and clinical reporting, case collaboration, clinical support of new customer implementation, liaison with care management staff, workflow creation, education on Aetna’s programs, plan performance analysis using industry vertical-specific reporting, and customer training and education on reporting specific to their business.

• Provide consultative clinical insights based on analysis and identification of key drivers of results; includes analysis of high cost claimants, transplants, population health and other clinical trends. Use data to evaluate performance results, monitor engagement, and collaborate on opportunities for improvement.
• Develop and present clinical content and recommendations in customer facing meetings. Present findings and recommended actions to help improve performance and clinical outcomes and work collaboratively with internal/external partners to help track and resolve issues.
• Manage case collaboration.
• Support customized workflows that allow for collaboration and integration between Aetna Care Management team and customer-based clinical team. Examples include but not limited to: review of programs and resources available to high-cost claimants, network deficiency support with in-network resources, health and wellness education, and onsite population health support.
• Provide guidance to customer-aligned vendors in support of customer’s overall population health strategy.
• Network across the enterprise and with clinical operations and ACO team, as applicable, to optimize collaboration, efficiency, and impact. This includes scheduling case collaborations and integrating with internal and external care management teams and highlighting member impact outcomes.
• Recommend clinical programs and services that align with the customers’ strategies and help drive short- and long-term results.
• Act as a trusted clinical resource. Share industry trends and best practices.
• Provide input to customers’ population health strategy across the clinical spectrum.
• Other projects as assigned.

Required Qualifications

• Registered Nurse with Un-restricted license required
• Minimum 7 years of clinical experience (must include 3+ years acute hospital care).
• Minimum 7 years of experience in healthcare consulting, client reporting and analytics and/or clinical operations, business management; and/or any combination of education and experience, which would provide an equivalent background.
• 2+ years of managed care and/or case management background required.
• 3+ years proficient with Microsoft office product suite of services (word excel, power point, outlook)
• If candidate is not currently WELCOA certified they will need to complete this certification within 6 months at Aetna once in the role.

This is a customer-facing role with peak travel throughout the year estimated at 25-50%. Adjustments to be made to account for COVID. Currently all work is performed virtually.

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

• If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

• If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

• 2+ year demonstrated leadership skills; Preferred
• Ability to independently work across teams and departments in a matrix environment.
• Ability to establish relationships and build rapport.
• Background in patient engagement strategy and Clinically Integrated Network (CIN) development preferred.
• Master’s in Nursing is preferred.
• Must possess strong communication and presentation skills.

Education

• The minimum level of education desired for candidates in this position is a bachelor’s degree in Nursing.

Master’s in Nursing is preferred.

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.