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

Utilization Management Implementation Senior Business Consultant

Primary Location: Phoenix, Arizona
Additional Locations: AZ-Phoenix, AZ-Tucson, CA-Sacramento, CA-Woodland Hills, CO-Denver, FL-Orlando, GA-Alpharetta, IA-Cedar Rapids, KS-Wichita, MA-Lowell, MN-St Paul, MO-St Louis, MS-Ridgeland, NC-Raleigh, ND-Bismarck, NE-Omaha, NM-Albuquerque, NV-Las Vegas, NY-Rochester, OK-Oklahoma City, PA-Philadelphia, SC-Greenville, SD-Aberdeen, TN-Memphis, TX-Dallas, UT-Salt Lake City, WA-Seattle

This role is telework with 10-25% of travel required.

-Plan all aspects of complex utilization management (UM) implementation projects and other assignments
-Manage all project activities of multiple new and/or expansion health plan implementation projects
-Execute Franchise Model policies, procedures, workflows, systems and training materials and modify to incorporate contract/regulatory specific requirements for state regulatory approval

Fundamental Components:
-Manage all new and/or expansion of complex utilization management health plan implementation projects in collaboration with the Aetna Medicaid Implementation Leadership team.
-Manage project scope, and deliverables within specified deadlines while continuously assessing project change requirements in alignment with state contracts and change relative to the agreed scope.

Background Experience:

-An RN or licensed social worker is preferred
-3+ years experience with several of the following methodologies: management consulting, project consulting, business process consulting, strategic business planning, and/or risk management consulting required
-3+ years experience in utilization management isrequired

-3+ years of Medicaid experience is required
-Experience with enterprise-wide and/or cross-functional large scale initiatives with high degree of complexity is preferred
-Demonstrated experience successfully implementing change in complex organizations is preferred
-Demonstrated superior business process, project management and organizational redesign experience is preferred
-Demonstrated leadership with relevant initiatives: Business process, enterprise business project management/consulting, strategic planning, risk management is preferred
-Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously is preferred

Additional Job Information:
Team leadership and team building skills.
Analytical and planning skills.
Negotiation/influencing skills.
Relationship and change management skills.
Organizational skills.
Time management skills.
Critical thinking skills.
Oral and written communication skills.

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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