Clinical Program Consultant (CPC) - WFH flexible

CVS Health

Houston, TX, USA Remote

Full time

Oct 13

Excellent opportunity for an experienced clinician with a passion for consulting and improving overall population health to leverage clinical, analytic and consultative skills to join our team of Clinical Program Consultants (CPC) who offer clinical insights and solutions to help improve health plan performance for our group commercial plan sponsors. This is a clinical transformation-type role to support clients with ACO-like needs; experience with joint ventures, provider collaboration, or Accountable Care organizations required. Highly collaborative, individual contributor position in a professional environment working with the account team, Aetna’s customer and ACO, Aetna’s clinical operation teams and our Plan Sponsor Insights team of consultants. The CPC will support one of our most important customers – a large health system in southeast Texas – with a focus on helping ensure patients receive the right care at the right time and advancing health. The candidate will work directly with the benefits team, onsite, at their location in Houston using healthcare analytics to identify opportunities for improvement. There will be the opportunity to partner onsite with the customer as well as work virtually.


Clinical Program Consultants are key members of Aetna’s Plan Sponsor Insights (PSI) business – a business focused on providing insights and solutions based on analytics to customers in the group commercial business. The work environment supports and thrives on out-of-the box thinking, creative talent and a consultative approach. Our team is highly valued by our internal partners as well as the customers we serve.


Fundamental Components of the position:

• Provide clinical consultation based on analysis and identification of key drivers of results e.g. use data to identify clinical trends, evaluate performance results, monitor engagement and collaborate on opportunities for improvement

• Recommend clinical programs and services that align with the customer’s population health strategy and help drive short and long term results e.g. assisting with development of health strategies, tactics, policies and programs (which could include network management, clinical coverage, care management, and compliance policies for data and information) that improve overall population health and encourage efficient and effective delivery of benefits.

• Development and presentation of clinical content and recommendations in customer facing meetings e.g. present findings and recommended actions to help improve performance and clinical outcomes, and work collaboratively to help track and resolve issues

• Act as a trusted clinical resource providing clinical program guidance

• Collaborate across the enterprise and with clinical operations and the ACO to optimize collaboration, efficiency, and impact

• Provide input to the design of clinical solutions and workflows leveraging knowledge of workflow, policy, and procedures to help ensure teams can work collaboratively

• Stay current on, and share knowledge of, population health trends

Required Qualifications

• Unrestricted Registered Nurse (RN) License

• Minimum of 5 years clinical experience (may be a combination of different sites of care practice including: hospital, clinic, and/or community health) with a strong understanding of clinical decision support platforms, EMR, and other technologies and data sources used within a healthcare delivery system

• This will require onsite work in the central Houston area minimum 1 day per week and up to 5 days per week based on business needs (post-COVID restrictions)

• 1+ years of experience with medical management products, programs, and services

• Strong clinical analytic skills and demonstrated conceptual thinking; required

• Strong problem-solving skills and attention to detail

• Experience working with a Health Insurance Carrier, benefit plan design

• Excellent consultative, communication and presentation skills (ability to take complex content and facilitate understanding for the audience including preparing and presenting effective and compelling power point slides

• Ability to establish highly collaborative relationships within and outside the organization including at the executive level

• Experience with workflow development/process design

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

• 1+ years of experience in, and knowledge of, the healthcare industry and market

• 3+ years of experience with joint ventures, provider collaboration, or Accountable Care organizations

• 1+ years of Healthcare Consultation Experience working with External Constituents

• 1+ years Leadership experience

Education

Bachelor’s degree or equivalent experience required

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.


We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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CVS Health is the leading health solutions company that delivers care in ways no one else can. We help people navigate the health care system — and th...

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