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Senior Clinical Strategist

Primary Location: Allentown, PA
Additional Locations: PA-Allentown
Full-time telework opportunity.

Facilitates improvement across multiple ACOs relative to improved management of medical spend, quality measures and member satisfaction. Develops and manages agenda of prioritized savings plan and initiatives to improve care delivery for each assigned ACO network.

Fundamental Components:
Analyzes medical spend data and identifies key improvement opportunities for ACO to address. Communicates compelling and concise results to empower client groups in decision making regarding initiative opportunities. Provides recommendations around the identification and implementation of care transformation programs within the client organization that will improve quality, increase efficiency and drive cost savings. Opportunities may include reduction of admissions, better member alignment and engagement with primary care physicians, enhanced post discharge follow-up and improvement in closing quality care gaps. Facilitates ACO leadership team to develop improvement initiatives to address prioritized savings opportunities. May include development of collaborative workflows, enhanced communication tools and processes and creation of reporting indicators (leading and lagging measures) to track success.

Promotes effective change leadership and facilitates issue resolution and speed to solution for each ACO in addressing their transformation roadmap. Responsible for achieving at least 2% annually in medical spend savings for each ACO and demonstrating improvement in quality measure completion. Strives to help each assigned ACO attain their contractual savings and quality targets so that ACS relationship remains strong and successful. Collaborates with Market Operations, ACS marketing and sales and National Accounts team to create messaging on the value-add of our ACOs. Supports Plan Sponsor interactions to demonstrate the value of ACO relationship to Plan sponsor and their employees. Participates in the assessment of providers’ capability infrastructure for population health management and identifies any capability gaps that need to be addressed for success with ACS product offering or risk based arrangement. (pre and post deal with ACS).

Background Experience:
7+ years of experience in either payer or provider relations
5+ years of experience in healthcare required
1+ years of experience with performance improvement required

RN licensure preferred
Deep knowledge of health care industry, policy, research design, predictive modeling, ACO finance methods and tools
Outstanding verbal and written communication skills, including formal presentations for all levels of management combined with strong collaboration/influencing abilities.
Background in health care analysis methods and tools, Population health, care management including disease management, complex care and end of life
Strategic business acumen and proven organizational, management, and leadership skills.Ability to collaborate with and understand the needs of C-level executives and help translate those needs to an actionable plan

Additional Job Information:
Can work in: Mid-Atlantic Region – PA, OH, KY, VA

Nursing - Registered Nurse (RN)

Potential Telework Position:

Percent of Travel Required:
10 - 25%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
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.

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