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Health Service Manager

Primary Location: New York, NY
Additional Locations: NY-New York
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Description:

Office-based position in New York City.

Come join Aetna Digital! We are looking for an experienced clinician with an analytics background to contribute to the creation and maintenance of the CareEngine – Aetna’s evidence-based clinical analytics platform. The candidate will play an integral role in the development of evidence-based content, clinical analytics and decision support algorithms. The candidate must possess a strong background in the use of clinical informatics and setting up clinician workflows to support clinical decision support and quality algorithms. This involves reviewing clinical literature from many sources, interpreting impact to our analytics platform, translating evidence-based recommendations into clinical rules, and presenting recommendations to a committee of board-certified physicians, pharmacists and registered nurses. These activities require advanced clinical, technical, analytic and consultative skills, extensive knowledge of health care data and information systems, as well as an understanding of epidemiology, health care benefits and health care delivery systems.



Fundamental Components:
  • Research, review and present medical literature to a clinical committee for the updating and development of clinical decision support analytic rules. Collaborate with Board-Certified physicians, pharmacists, registered nurses, clinical operations and IT on product design, development and testing.

  • Review and update of ICD, CPT, NDC, LOINC, HIE, and ADT codes in the database to maintain compliance with external mandatory regulations. Partner with product management and account management to configure and enhance care management and consumer facing product suite.

  • Investigate inquiries from clinical operations regarding the program and member-level questions.

  • Support the implementation of clinical products via configuration in our account administration system

  • Support non-clinical digital product teams as a clinical SME

  • Assisting IT and QA team in completing clinical systems testing.

  • Participate in continuing educational activities, as appropriate.



Background Experience:

RN licensure or Licensed Pharmacist required
5+ years clinical experience or managed care experience required

Ability to search, analyze and synthesize clinical literature

Proactively builds and maintains internal and external key relationships.
Capable of developing and delivering of analytical solutions in support of healthcare business initiatives that drive the short and long-term objectives.
Ability to perform and manage multiple activities and changing priorities.
Ability to work independently and adapt to team approach as necessary.
Ability to handle an environment with rapidly changing priorities
Strong organizational and detail-oriented skills.
Strong oral, written and interpersonal skills.



Additional Job Information:
Previous experience related to medical billing in a hospital or health system.

Required Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Consulting for Solutions

Desired Skills:
Leadership - Anticipating and Innovating, Leadership - Collaborating for Results, Technology - Selecting and Applying Technology Solutions

Functional Skills:
Clinical / Medical - Clinical claim review & coding, Clinical / Medical - Consultative informatics, Clinical / Medical - Disease management

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

Education:
Nursing - Registered Nurse (RN), Pharmacy - Licensed Pharmacist

Potential Telework Position:
No

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 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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