Senior Business Consultant - 64564BRPrimary Location: Woodland Hills, CA
Additional Locations: CA-Santa Ana, CA-Woodland Hills Apply
Local quarterback with dual responsibilities in maintaining/improving market Stars ratings and risk adjustment; executes on STARS strategy as (local) extension to Segment best practices; resources dual responsibilities in maintaining/improving market Stars ratings and risk adjustment; executes on STARS strategy as (local) extension to Segment best practices / resources
64564Fundamental Components: Focused on quality performance, executing on national initiatives at local market level
Identify local market STARS and RAR strategies and manage local quality programs (
Manage and direct local vendors
Conduct data analysis, in conjunction with national tools, to identify opportunity areas and paths on track; assure member metrics being met
Oversees team of embedded coders with coordination from national team
Engage with clinical team and specific clinics, medical groups, hospitals; attends JOM meetings; Supports engagement managers and RN program managers as needed
Additional dock-in points needed to manage include MSO, product, sales, network, performance, MEU
Monitors and trends member complaints, grievances and appeals in the local market and creates mitigation plans. Background Experience: 3+ years of Medicare Advantage experience with heavy focus in STARS/Risk Adjustment areas
Fluent in Quality standard principles including Stars, HEDIS and Medicare Risk Adjustment
Ability to foster trust/relationships with internal partners and key provider groups
Ability to execute strategy and devise plans
Demonstrated leadership with relevant initiatives: Business process, enterprise business project management/consulting, financial strategic planning and analysis, strategic planning, risk management.
Experience with several of the following methodologies: management consulting, project consulting, business process consulting, financial strategic analysis, mergers and acquisitions, strategic business planning, and/or risk management consulting.
Masters degree preferred, but not required.
#LI-DI1 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: No 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.
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