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Clinical Program Consultant (HBS)

Primary Location: Houston, TX
Additional Locations: TX-Houston, TX-Sugar Land
Excellent opportunity for an experienced clinician with a passion for consulting and improving overall population health to leverage clinical, analytic and consultative skills to join our team of Clinical Program Consultants (CPC) who offer clinical insights and solutions to help improve health plan performance for our group commercial plan sponsors. This is a clinical transformation-type role to support clients with ACO-like needs; experience with joint ventures, provider collaboration, or Accountable Care organizations required. Highly collaborative, individual contributor position in a professional environment working with the account team, customer and ACO, Aetna's clinical operation teams and our Plan Sponsor Insights team of consultants. The CPC will support one of our most important customers - a large health system in Southeast Texas with a focus on helping ensure patients receive the right care at the right time and advancing health - working directly with the benefits team, onsite, at their location in Houston using analytics to identify opportunities for improvement.

Clinical Program Consultants are key members of the Plan Sponsor Insights (PSI) business - a business focused on providing insights and solutions based on analytics to customers in the group commercial business. The work environment supports and thrives on out-of-the box thinking, creative talent and a consultative approach. Our team is highly valued by our internal partners as well as the customers we serve.

Fundamental Components:
  • Provide clinical consultation based on analysis and identification of key
    drivers of results e.g. use data to identify clinical trends, evaluate performance results, monitor engagement and collaborate on opportunities for improvement
  • Recommend clinical programs and services that align with the customer's
    strategy and help drive short and long term results e.g. assisting with development of health strategies, tactics, policies and programs (which could include network management, clinical coverage, care management, and compliance policies for data and information) that improve overall population health and encourage efficient and effective delivery of benefits.
  • Development and presentation of clinical content and recommendations in
    customer facing meetings e.g. present findings and recommended actions to help improve performance and clinical outcomes, and work collaboratively to help track and resolve issues
  • Act as a trusted clinical resource providing clinical program guidance
  • Collaborate across the enterprise and with clinical operations and ACO to optimize collaboration, efficiency, and impact
  • Provide input to the design of clinical solutions and workflows leveraging knowledge of workflow, policy, and procedures to help ensure teams can work successfully
  • Stay current on, and share knowledge of, population health trends

Background Experience:
  • Registered Nurse (RN) License; Required
  • Required Minimum of 5 years clinical experience (may be a combination of different sites of care practice including: hospital, clinic, and/or community health) with a strong understanding of clinical decision support platforms, EMR, and other technologies and data sources used within a healthcare delivery system
  • 1+ years of Healthcare Consultation Experience working with External Constituents; Required
  • 3+ years of experience with joint ventures, provider collaboration, or Accountable Care organizations; required
  • 1+ years Leadership experience; required
  • 1+ years of experience in, and knowledge of, the healthcare industry and market; Required
  • 1+ years experience with medical management products, programs and services; Required
  • Experience working with a Health Insurance Carrier, benefit plan design
  • Strong problem-solving skills and attention to detail
  • Strong clinical analytic skills and demonstrated conceptual thinking; required
  • Excellent consultative, communication and presentation skills (ability to take complex content and facilitate understanding for the audience including preparing and presenting effective and compelling power point slides
  • Ability to establish highly collaborative relationships within and outside the organization including at the executive level
  • Experience with workflow development/process design

Additional Job Information:

Must be able to be onsite fulltime at the customer location in Houston, TX and travel as needed ~0-10%. Flexibility to work at home 1x week.
If candidate is not currently WELCOA certified they will need to complete this certification once in the role.

Required Skills:
Benefits Management - Understanding Clinical Impacts, General Business - Communicating for Impact, General Business - Consulting for Solutions, General Business - Demonstrating Business and Industry Acumen, General Business - Turning Data into Information

Desired Skills:
General Business - Applying Reasoned Judgment, Leadership - Anticipating and Innovating, Leadership - Driving Change

Functional Skills:
Clinical / Medical - Consultative informatics, Clinical / Medical - Sales, Leadership - Act as company spokesperson to external constituents, Nursing - Case Management, Nursing - Disease management

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Nursing - Registered Nurse (RN)

Potential Telework Position:

Percent of Travel Required:
0 - 10%

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

Click To Review Our Benefits (PDF)


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