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Senior Business Consultant - 64564BR

Primary Location: Woodland Hills, CA
Additional Locations: CA-Santa Ana, CA-Woodland Hills
Office based in Woodland Hills, CA or Santa Ana, CA

Represent Aetna to our contracted providers and focus on executing on national initiatives at local market level through identifying local market Risk Adjustment opportunities to improve accuracy and completeness of captured codes.

Manage and direct local and national vendors around provider and member outreach and engagement.

Conduct data analysis, in conjunction with national tools, to identify opportunity areas and present to key stakeholders.

Provides feedback to providers on accuracy and improvement opportunities relevant to Risk adjustment.

Develops training documents and tools; assures that internal and external stakeholders related to CMS guidelines and Risk
Adjustment best practices.

Engage with clinical team and specific clinics, medical groups, hospitals; attends JOM meetings; Supports and interact with quality engagement managers and RN program managers as needed.

Additional dock-in points needed to manage include MSO, product, sales, network, performance, MEU.

Integrates risk adjustment activities with quality initiatives where possible.

Identifies alternate data sources and facilitates capture through corporate processes

Fundamental Components:
Requires minimum of a bachelor’s degree in a clinical, technical or quantitative field (health Sciences, health management, nursing, actuarial science, social science, healthcare) or equivalent combination of experience and education. MBA or other relevant

Master’s degree preferred, but not required.

Requires a minimum of 5+ years of healthcare industry experience.

Background Experience:
3+ years of Medicare Advantage experience with heavy focus in Risk Adjustment areas terms and best practices.
Thorough understanding of the financial/Clinical metrics and claims/encounters.
Experience in healthcare including provider network relationship management with a focus on California and experience in a consultative role.
Experience developing training programs and provider tools required.
Ability to foster trust/relationships with internal partners and key provider groups


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.

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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