Senior Clinical Program Consultant

Job Description

Excellent opportunity for a solution-oriented, experienced nurse with a passion for consulting to leverage their clinical, analytic, and consultative skills to join Aetna’s Plan Sponsor Insights (PSI) team of Clinical Program Consultants (CPCs).
Our talented CPCs offer clinical insights based on analytics and develop solutions to help improve health plan performance. This specific position will support an important and strategic National Account customer.. Key components of the role include advanced analytic and clinical reporting, case collaboration, clinical support of customer programs, liaison with care management staff, workflow creation, education on Aetna’s programs, and plan performance analysis to identify opportunities for improvement.

The CPC role is a highly collaborative role between internal and external constituents including: the account team, Aetna’s care management teams, and the customer’s employee benefits team. The work environment supports and thrives on out-of-the box thinking; leveraging all available assets to create an integrated support model.

Clinical Program Consultants are key members of the Aetna Plan Sponsor Insights (PSI) business – a business focused on providing data-drive 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.

Fundamental Components:

• Provide clinical consultation based on analysis and identification of key drivers of results i.e., use data to identify clinical trends, analyze high-cost claimants, transplants, population health and other clinical trends, evaluate performance results, monitor engagement, and collaborate on opportunities for improvement.
• Partnering with an analyst, drive deeper insight into cost, utilization, and member behavior
• Create solutions, and programming to address population health opportunities.
• 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.
• Provide guidance to customer aligned vendors in support of customer’s overall population strategy.
  Network across the enterprise and with clinical operations, as applicable, to optimize collaboration, efficiency, and impact. This includes scheduling case collaborations and integrating with internal and external care management teams.
• Recommend clinical programs and services that align with the customer’s strategy and help drive short- and long-term results.
• Act as a trusted clinical resource. Share industry trends and best practices. Support education and analysis of Social Determinants of Health and impact on population health management.
• Provide input to customers’ population health strategy across the clinical spectrum.
• Other projects as assigned.

This is intended to be a work at home role with travel between the customer’s locations as requested for key meetings e.g. bi-annual reviews. Adjustments will be made to account for COVID. Ideal candidate will reside in or near Charlotte, NC.

Required Qualifications

• Minimum of 7 years of experience in wellness healthcare consulting, client reporting and analytics and/or clinical operations, business management;
• 5 years leadership experience; and/or any combination of education and experience, which would provide an equivalent background.
• 3+ years of wellness program management.
• Registered Nurse with Un-restricted license required
• Minimum of 3 years acute hospital care
• 2+ years of managed care and/or case management background.
• 1+ years of independent work across teams and departments in a matrixed environment.
• 1+ years of established highly collaborative relationships within and outside the organization including at the executive level.
• 3+ years proficiency with Microsoft office products 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 through Aetna once in the role.

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

• Master’s in Nursing is preferred.
• Strong problem-solving skills and attention to detail.
• Strong communication and presentation skills.
• Certification in wellness

Education

• Bachelor’s degree in Nursing required; 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.