Job Description
Job Description
Remote candidate must reside in California.
Schedule is Monday-Friday standard business hours. No nights, no weekends and no holidays.
Works with assigned Aetna Medicare Provider Collaboration groups to drive improved performance by leading clinical performance improvement projects and managing multiple complex deliverables through to implementation. this position will focus on Provider Collaboration arrangements. Projects will support population health and will primarily impact Stars and quality with focus on improvements in utilization and costs.
The Senior Clinical Strategist works to drive clinical performance of assigned Provider Collaboration groups by:
-Establishing trusting relationship with provider partners to promote open communication
-Serving as clinical expert on actionable opportunities related to CM, gap closure, workflow discussions, and partnering with case manager supervisor/manager and CMs
-Serving as internal and external liaison and clinical resource, interpreting data and educating regarding how to utilize data for PC performance improvement
-Strategizing with subject matter experts and clinical teams both internally and externally to drive outcomes and improve efficiencies
-Coordinating and conducting clinically focused meetings to identify opportunities target and prioritize goals and interventions to close gaps in care and achieve optimal stars performance
-Collaboratively working across multiple functions and /or segments to obtain agreement from all impacted parties (e.g., up and downstream effects often impact multiple functions and/or segments.
-Collaborating with Engagement Managers, Local Market Team, Data Team, Medical Operations and others on initiatives for Stars/quality improvement.
Required Qualifications
Strong communication and interpersonal skills
Proven track record in meeting project milestones and negotiating for resources.
Proven negotiation skills.
Proven project management skills.
Proven success while working in a matrixed environment Supervisory or leadership experience
Nursing License Registered Nurse must be active & unrestricted in the state the candidate resides.
Functional Experience
Nursing - Case Management/4 Years
Nursing - Medical-Surgical Care/1 Year
Medical Management - Medical Management
1 year Managed Care/Insurance/Payor Clinical Staff
3 years Supervisory or leadership experience
Preferred Qualifications
Desired Skills
Creating Accountability
Developing and Executing Strategy
Driving Change
Technology Experience
Desktop Tools - Microsoft Outlook
Desktop Tools - Microsoft PowerPoint//End User
Desktop Tools - TE Microsoft Excel/End User
Desktop Tools - Microsoft SharePoint/End User
Education
Bachelor's degree or equivalent experience
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.
Remote candidate must reside in California.
Schedule is Monday-Friday standard business hours. No nights, no weekends and no holidays.
Works with assigned Aetna Medicare Provider Collaboration groups to drive improved performance by leading clinical performance improvement projects and managing multiple complex deliverables through to implementation. this position will focus on Provider Collaboration arrangements. Projects will support population health and will primarily impact Stars and quality with focus on improvements in utilization and costs.
The Senior Clinical Strategist works to drive clinical performance of assigned Provider Collaboration groups by:
-Establishing trusting relationship with provider partners to promote open communication
-Serving as clinical expert on actionable opportunities related to CM, gap closure, workflow discussions, and partnering with case manager supervisor/manager and CMs
-Serving as internal and external liaison and clinical resource, interpreting data and educating regarding how to utilize data for PC performance improvement
-Strategizing with subject matter experts and clinical teams both internally and externally to drive outcomes and improve efficiencies
-Coordinating and conducting clinically focused meetings to identify opportunities target and prioritize goals and interventions to close gaps in care and achieve optimal stars performance
-Collaboratively working across multiple functions and /or segments to obtain agreement from all impacted parties (e.g., up and downstream effects often impact multiple functions and/or segments.
-Collaborating with Engagement Managers, Local Market Team, Data Team, Medical Operations and others on initiatives for Stars/quality improvement.
Required Qualifications
Strong communication and interpersonal skills
Proven track record in meeting project milestones and negotiating for resources.
Proven negotiation skills.
Proven project management skills.
Proven success while working in a matrixed environment Supervisory or leadership experience
Nursing License Registered Nurse must be active & unrestricted in the state the candidate resides.
Functional Experience
Nursing - Case Management/4 Years
Nursing - Medical-Surgical Care/1 Year
Medical Management - Medical Management
1 year Managed Care/Insurance/Payor Clinical Staff
3 years Supervisory or leadership experience
Preferred Qualifications
Desired Skills
Creating Accountability
Developing and Executing Strategy
Driving Change
Technology Experience
Desktop Tools - Microsoft Outlook
Desktop Tools - Microsoft PowerPoint//End User
Desktop Tools - TE Microsoft Excel/End User
Desktop Tools - Microsoft SharePoint/End User
Education
Bachelor's degree or equivalent experience
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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