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A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Medicare Stars/RAF Lead

Primary Location: Belmar, New Jersey
Additional Locations: NJ-Belmar, NJ-Parsippany, NJ-Princeton
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Description:
Position Summary:
Local quarterback with dual responsibilities in maintaining/improvingmarket Stars ratings and risk adjustment; executes on STARS strategy as (local)extension to Segment best practices / resources

Fundamental Components:
Works across local market leadership to establish and champion for alocal market culture committed to STARS and RAR excellence
Focused on quality, executing on nationalinitiatives at local level
Identify and develop local market STARS andquality strategies; manage local quality programs (e.g., PEP)
Monitor and trend member complaints, grievancesand appeals in the local market and support local activities to mitigateissues
Manage and direct local vendors
Ensure compliance across various elements tominimize risk
Conduct data analysis, in conjunction withnational tools, to identify opportunity areas and paths on track; assure membermetrics being met
Identify which VBCs/non-VBCs to prioritize withHEDIS and RA initiatives
Produce content for training tools for agentsdeveloped around market needs (CTM drivers, RAF trends)
Engage with clinical team and specific clinics,medical groups, hospitals; attends JOM meetings; Supports engagement managersand RN program managers
Support local market colleagues in ensuringstrategic and optimal bids; attends/hosts trainings
Additional dock-in points needed to manageinclude MSO, product, sales, network, performance, MEU



BACKGROUND/EXPERIENCE desired:

Health insurance / managed care
Quality standards principles, including Stars,HEDIS, MRA
Ability to foster trust/relationships with keyprovider groups
Strong data and financial analysis acumen
Supervisory experience
Ability to execute strategy and devise plans

EDUCATION
The highest level of education desired for candidates in this position is a Master's degree.

REQUIRED SKILLS
General Business/Applying Reasoned Judgment/MASTERY
General Business/Consulting for Solutions/ADVANCED
General Business/Ensuring Project Discipline/MASTERY


DESIRED SKILLS
Leadership/Anticipating and Innovating/ADVANCED
Leadership/Driving Strategic and Organizational Agility/MASTERY
Service/Working Across Boundaries/MASTERY


ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.





Benefit eligibility may vary by position. Click here to review the benefits associated with this position.



Aetna takes our candidates'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.



Potential Telework Position:
Yes

Percent of Travel Required:
10 - 25%

Click To Review Our Benefits (PDF)

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