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Population Health Specialist

Primary Location: Richmond, Virginia
Additional Locations: VA-Richmond
The Population Health Specialist (PHS) will be part of a high-performing team working in the local Virginia health plan market and be responsible for management of relationships with key providers tied to Aetna Medicaid’s value-based initiative.

Fundamental Components:
The PHS will serve as part of the local health plan in VA that is responsible for carrying out our population health and clinical integration strategy through the following activities:
  • Coordinating care and services between the local health plan care management and quality teams and our value-based solution (VBS) partners
  • Monitoring analytics and utilization/quality/cost trends including high-risk and emerging-risk member identification and early identification of care intervention opportunities for our VBS and other key partners
  • Work across the provider and local care and service community to drive relationships and care coordination opportunities to ensure the full continuum of care is available to our members including building relationships with LTSS, behavioral health, pharmacy, home and community- based providers, patient-centered medical homes, health homes, community mental health centers
  • Lead the tactical and clinical execution of the local market value-based and population health care strategy working closely with national VBS team, network team, local health plan and technology vendor to build existing and establish new accountable provider relationships creating a common vision and care approach
  • Work with our provider partners and national shared services team to enhance, establish or refine provider workflows to create common procedures and protocols to best meet our members’ needs which include but are not limited to: readmission programs, transitions of care, quality gaps in care and of alignment with the health plan integrated care management team
  • Lead regular meetings with the provider clinical care teams to ensure optimal care coordination, program innovation, clinical decision making, contract execution and evaluation
  • Will provide partner education and adoption support for Aetna’s population health management tools and processes reinforcing a member-centered approach and common approach to care coordination
  • Will seek out new opportunities to enhance, improve and optimize local care delivery and member engagement through clinical/social programming, data sharing or technology with community-based partners
  • Will participate with the larger population health and Medicaid Innovation team to continue on-going program design, development and evaluation
  • Will present outcomes of population health work at a local or national conference, symposia, or association meetings

Background Experience:
  • Experience within an accountable care organizations and/or population health management within a provider organization or health plan- any experience with a new delivery model or healthcare transformation, patient-centered medical home, Centers for Medicare and Medicaid grant implementation etc.
  • Excellent written, verbal and presentation skills, equally comfortable presenting to the provider’s senior leadership, the local clinical teams or meeting directly with members in a care setting
  • Care management experience with either a provider or health plan
  • Expert analytical and critical thinking skills – strong desire to use analytics and data trends to drive care management, risk stratification and predictive modeling
  • ‘Executive ready’ to take on increasing responsibility and leadership roles as key accountable care provider partnerships evolve and mature
  • Expert project management skills- able to manage many relationships simultaneously and simultaneously lead several initiatives- able to hit targets, deadlines and proactively establish day-to-day priorities
  • Expert collaborator and team-building skills able to take disparate systems and build, maintain and grow a high performing team and set of programs
  • Creative thought leader who finds a way to get to “yes” with achievable outcomes --- able to keep focused and separate out the true signal in the noise--- can overcome inertia, fear of change and uncertainty by keeping a positive focus and approach

Additional Job Information:
Because this position is very provider-facing in the local state market, it is anticipated that at least 50% of all time will be spent working in the local provider community within their clinics and offices. This position will also be accountable to the local health plan and will be expected to meet at the local health plan office on a regular basis- this position will also maintain work at home time:
  • Travel – within the state 50% - it is expected that PHS will meet regularly with the health plan and the local providers
  • Limited travel outside the state to meet with teams in other markets

Required Skills:
Benefits Management - Interacting with Medical Professionals, General Business - Turning Data into Information, Leadership - Collaborating for Results

Functional Skills:
Clinical / Medical - General Management, General Management - Data analysis & interpretation, Medical Management - Medical Management - Managed Care/Insurance Administration

Technology Experience:
Desktop Tool - Microsoft Outlook, Operating System - Windows

Potential Telework Position:

Percent of Travel Required:
25 - 50%

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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