Job Description
Job Description
The Care Management (CM) Program Integrity Team is made up of clinical and non-clinical staff who serve as subject matter experts for the Aetna Medicaid care management program. The team creates, maintains, and supports the implementation of the program elements designed to meet NCQA and CMS requirements and the needs of Aetna Medicaid members. The Program Integrity team consults and contributes across departments to develop new program content and measures of success. The team works closely with health plan staff to ensure program metrics are met. 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. Its a great time to join Aetna a CVS Health company; we are healthcare innovators.
Position Mission:
This new role within the CM Program Integrity team will partner with the existing team to extract, collect, analyze, and interpret health, utilization and financial data from many sources. The data collected is tell the story that address business questions regarding population health management, health and economic outcomes, quality of healthcare, healthcare program and product design, healthcare provider network design and other business needs.
* Perform validation testing and analyses of varied healthcare data to evaluate the care management program using healthcare, pharmacy, lab, survey and utilization data.
* Extract and maintain integrity of data from multiple sources to include the CM business application (e.g. Dynamo, MedCompass) to create integrated analytic datasets, reports, and studies to address business and research questions.
* Execute univariate and multivariate statistical analyses and interprets results in the context of the business problem or question.
* Develops standardized reports that contribute to the development of methods and technical specifications to respond to stakeholder requests;
* Collaborates with the full team to writing and presentation of results, findings, and conclusions.
* Manages personal resources efficiently to complete assigned projects accurately and produce quality, on-time deliverables.
* Sustains curiosity and willing to probe into technical details and data irregularities to effectively achieve common goals.
Required Qualifications
Background Experience
Desired
* 3+ years of relevant programming or analytic experience with demonstrated analytical and problem-solving skills.
* Healthcare or pharmaceutical industry experience is preferred.
* Demonstrated written and verbal communication skills. Able to present the story to various levels and audiences.
* Understanding of relational databases, data systems, data warehouses, and other established informatics reporting tables.
* Knowledge of analytic programming tools and methods (SAS, SQL, OLAP, Business Objects, Crystal).
* Knowledge of health care industry, policy, research design, univariate and multivariate statistical analyses, predictive modeling, case-mix and risk adjustment methods and tools.
* Healthcare or pharmaceutical industry experience is preferred.
Preferred Qualifications
See Required Qualifications
Education
Bachelor's degree in Mathematics, Economics, Statistics, Computer Science, Actuarial Science, Social Science, Healthcare or related discipline.
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.
The Care Management (CM) Program Integrity Team is made up of clinical and non-clinical staff who serve as subject matter experts for the Aetna Medicaid care management program. The team creates, maintains, and supports the implementation of the program elements designed to meet NCQA and CMS requirements and the needs of Aetna Medicaid members. The Program Integrity team consults and contributes across departments to develop new program content and measures of success. The team works closely with health plan staff to ensure program metrics are met. 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. Its a great time to join Aetna a CVS Health company; we are healthcare innovators.
Position Mission:
This new role within the CM Program Integrity team will partner with the existing team to extract, collect, analyze, and interpret health, utilization and financial data from many sources. The data collected is tell the story that address business questions regarding population health management, health and economic outcomes, quality of healthcare, healthcare program and product design, healthcare provider network design and other business needs.
* Perform validation testing and analyses of varied healthcare data to evaluate the care management program using healthcare, pharmacy, lab, survey and utilization data.
* Extract and maintain integrity of data from multiple sources to include the CM business application (e.g. Dynamo, MedCompass) to create integrated analytic datasets, reports, and studies to address business and research questions.
* Execute univariate and multivariate statistical analyses and interprets results in the context of the business problem or question.
* Develops standardized reports that contribute to the development of methods and technical specifications to respond to stakeholder requests;
* Collaborates with the full team to writing and presentation of results, findings, and conclusions.
* Manages personal resources efficiently to complete assigned projects accurately and produce quality, on-time deliverables.
* Sustains curiosity and willing to probe into technical details and data irregularities to effectively achieve common goals.
Required Qualifications
Background Experience
Desired
* 3+ years of relevant programming or analytic experience with demonstrated analytical and problem-solving skills.
* Healthcare or pharmaceutical industry experience is preferred.
* Demonstrated written and verbal communication skills. Able to present the story to various levels and audiences.
* Understanding of relational databases, data systems, data warehouses, and other established informatics reporting tables.
* Knowledge of analytic programming tools and methods (SAS, SQL, OLAP, Business Objects, Crystal).
* Knowledge of health care industry, policy, research design, univariate and multivariate statistical analyses, predictive modeling, case-mix and risk adjustment methods and tools.
* Healthcare or pharmaceutical industry experience is preferred.
Preferred Qualifications
See Required Qualifications
Education
Bachelor's degree in Mathematics, Economics, Statistics, Computer Science, Actuarial Science, Social Science, Healthcare or related discipline.
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.
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