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

Director, Strategic Initiatives

Primary Location: Hartford, CT
Additional Locations: CT-Hartford
The ideal candidate will lead the Strategic Initiatives & Program Solutions team within Medical Policy and Program Solutions (MPPS). This includes overseeing MPPS strategic projects, CVS/Aetna integration, membership migrations, clinical program solutions, and managing our clinical program vendor relationships.

Fundamental Components:
  • Lead strategic program installation and expansion projects (Third Party Claim & Code Review Program, including Cotiviti PCA and Clinical Validation)
  • Lead/support CVS/Aetna integration projects (including installation of NovoLogix preauthorization and claim editing)
  • Support strategic claim and clinical platform development and migration (MedCompass, HRP)
  • Provide business leadership on strategic systems enhancements (ClaimsXten Optimization, Strategic Precertification)
  • Develop new MPPS programs and concepts to meet business targets and clinical outcomes
  • Manage clinical program vendor relationships and finance for Milliman Care Guidelines (MCG Health) and vendors providing outbound phone calling and SMS/text services for Aetna and ActiveHealth Management member outreach programs (Nuance, Welltok, West Interactive Service Corp). This includes contracting and relationship management, SOW development, day-to-day operational oversight, AP, invoicing and reconciliation processes, reporting, budget forecasting, liaison to segment partners for budget planning
  • Oversee MCG care guidelines implementation, including ensuring accurate updates to Goal Length of Stay (GLOS), reviews with clinical leadership, and configurations and installations in ATV and MedCompass
  • Oversee Aetna and ActiveHealth Management member outreach programs technical solutions, including flow control coordination for DM/HLC/LCC operations, MedQuery data feeds to ActiveHealth Management, supporting MedQuery case installations, and SAS coding for operational reporting
  • Partner with MPPS leadership to support forecasting claim editing vendor and IT budgets
  • Provide ad hoc project support on various MPPS initiatives as needed, including participation in ABX and Finance related projects

Background Experience:
Demonstrated negotiation skills. Proven track record managing complex projects and or programs that resulted in cost savings. Multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes. Experience managing large budgets.10+ years managed care / health insurance industry experience. Project management experience. Supervisory experience. Bachelor's degree or equivalent experience. Registered nurse preferred, but not required.

Additional Job Information:
This position will report directly to the head of Medical Policy & Program Solutions. Our core team is located in multiple cities across the country. Position can be located in any Aetna office or current teleworker, and must be available during standard operating hours Mon-Fri in order to meet business needs. We function in a fast-paced environment, which recognizes and rewards strong performers. You will work with a supportive management team in a positive atmosphere with a teamwork approach that provides multiple development opportunities.

Required Skills:
Finance - Managing Aetnas Risk, General Business - Consulting for Solutions, General Business - Ensuring Project Discipline

Desired Skills:
General Business - Communicating for Impact, Leadership - Collaborating for Results, Leadership - Driving Change

Functional Skills:
Clinical / Medical - FE Clinical coverage & policies, Communication - Communication Development - Executive level presentations, Finance - Financial Forecasting, Management - Management - Vendor (non IT), Project Management - Enterprise-wide project management

Technology Experience:
Aetna Application - Aetna Total clinical View, Aetna Application - Automated Claim Adjudication System, Aetna Application - ClaimXten (McKesson software), Database - Intuit QuickBase, Database - Oracle

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. Click here to review the benefits associated with this 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.

Click To Review Our Benefits (PDF)


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