Clinical Program Consultant (Dedicated, Sr CPC, Texas)

CVS Health

Houston, TX, USA

Full time

Healthcare / Insurance

Jul 26

This is a hybrid telework role with the expectation of time onsite with the plan sponsor in Houston, Texas and travel as needed. Onsite visits to customer location semi-monthly based on business needs. Up to 50% for ramp-up travel Post-COVID restrictions.

Excellent opportunity for experienced healthcare professional 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 a client with ACO-like needs; experience with joint ventures, provider collaboration, or Accountable Care organizations highly preferred. Highly collaborative, strong 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 components of the role include:

• Provide clinical consultation based on analysis and identification of key drivers of results e.g. use data to identify clinical trends. Evaluates performance results, monitors engagement, proactively identifies and collaborates 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.

• Perform independent 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

• Research and evaluate programs and processes to identify savings and efficiency opportunities that may result in policy and procedure changes that impact the customer and the enterprise

• 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

• Provide coaching, direction, feedback, and support of other matrixed team members including external vendors to drive integrated value for the plan sponsor.

The candidate will work directly with the benefits team, at their location in Houston using healthcare analytics to identify opportunities for improvement. Solutions from the data and customer experience will be developed at an individual level and incorporated into the team strategy. Ideal candidates will be able to leverage advanced industry and clinical knowledge and utilize resources to turn data into actionable and measurable opportunities. There will be 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.

Required Qualifications

• Minimum of 7 years experience in a clinical/healthcare setting (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

• 3+ years of experience with enterprise-wide and/or cross-functional large-scale initiatives with high degree of complexity.

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

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

• 5+ years Leadership experience

• 3+ years of utilizing Excel and other reporting mechanisms to support analysis

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications

• Experience working with a Health Insurance Carrier

• Experience with benefit plan design

• Strong clinical analytic skills and demonstrated conceptual thinking

• Strong problem-solving skills and attention to detail

• Experience communicating for impact; driving change

• Excellent consultative, communication and presentation skills (especially PowerPoint); ability to take complex content and facilitate understanding for the audience

• Comfortable with organizing and responding to multiple deliverables in a timely and professional manner

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

• Proficient with MS Office programs


Bachelor’s degree or 5 years of equivalent work experience required

Masters’ s degree or 7 years of equivalent experience preferred

Registered Nurse License in active and good standing RN license or LCSW preferred but not required

Business Overview

Bring your heart to CVS Health

Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day.

CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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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...