Category: Curator- Job Hunter

 
 

 
 

Found in: beBee S US

Description:

Resp & Qualifications

Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective,
concurrent and retrospective reviews for authorization, appropriateness of care determination and benefit coverage.
Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical
information, contracts, mandates, medical policy, evidence based published research, national accreditation and
regulatory requirements contribute to determination of appropriateness and authorization of clinical services both
medical and behavioral health.
ESSENTIAL FUNCTIONS
Weight Essential Functions
50% Determines medical necessity and appropriateness by referencing regulatory mandates, contracts, benefit
information, Milliman Care Guidelines, Apollo Guidelines, ASAM (American Society of Addiction Medicine),
Medicare Guidelines, Federal Employee Program and Policy Guidelines, Medical Policy, and other
accepted medical/pharmaceutical references (i.e. FDA, National Comprehensive Cancer Network, Clinical
trials.Gov, National Institute of Health, etc.) Follows NCQA Standards, CareFirst Medical Policy, all
guidelines and departmental SOPS to manage their member assignments. Understands all CareFirst lines
of business to include Commercial, FEP, and Medicare primary and secondary policies.
30% Conducts research and analysis of pertinent diseases, treatments and emerging technologies, including
high cost/high dollar services to support decisions and recommendations made to the medical directors.
Collaborates with medical directors, sales and marketing, contracting, provider and member services to
determine appropriate benefit application. Applies sound clinical knowledge and judgment throughout the
review process. Coordinates non-par provider/facility case rate negotiations between Provider Contracting,
providers and facilities. Follows member contracts to assist with benefit determination.
20% Makes appropriate referrals and contacts as appropriate. Offers assistance to members and providers for
alternative settings for care. Researches and presents educational topics related to cases, disease entities,
treatment modalities to interdepartmental audiences.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The
requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education Level: Bachelor’s Degree
Education Details: Nursing
Experience: 5 years Clinical nursing experience
2 years Care Management
In Lieu of Education
In lieu of a Bachelor’s degree, an additional 4 years of relevant work experience is required in addition to the
required work experience.
Preferred Qualifications
Working knowledge of managed care and health delivery systems.
Thorough knowledge of CareFirst clinical guidelines, medical policies and accreditation and regulatory standards
Working knowledge of CareFirst IT and Medical Management systems, familiarity with

 
 

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Description:

Serves as a point of contact for health care services and referrals for members with medical and behavioral health needs. Reviews encounter forms/claims to identify all potential case management service needs and collaborates with RN case managers, e Associate, Clinical, Outreach, Management, Health, Medical

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Location:

This is a Work-At-Home position.  However, the selected candidate must live within commutable distance from an Anthem office.
The Proposal Writer Sr. is responsible for writing strategic, highly customized, complex proposal responses to win and retain existing business. Primary duties may include, but are not limited to:
Develops written solutions incorporating complex, custom win strategies based on local market needs, leveraging best practices, brand standards, innovative ideas, and reviewer insights. Identifies and creates standard content for the proposal database and edits content as needed. Aligns multiple written communication efforts with the overall Anthem messaging and goals. Partners with Subject Matter Experts (SMEs) to transfer knowledge, develop new solutions, obtain direction and create alternative solutions.

Researches, recommends and develops creative approaches and solutions to content. Serves as a key communications resource for business leaders and collaborates across various areas to support enterprise-wide selling initiatives.

Qualifications

Requires a BA/BS degree; 5 years of health care specific proposal writing experience; or any combination of education and experience, which would provide an equivalent background.

Experience working in a heavily matrixed environment and proven relationship-building skills required. Expert level experience in managing large-scale proposals or communication initiatives including writing and reviewing healthcare bids for healthcare companies in a deadline-driven environment required.

Applicable to Colorado Applicants OnlyAnnual Salary Range*: $84,084 – $126,126

Actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level.  
* The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting.  The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future.  

No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Clipped from: https://www.learn4good.com/jobs/richmond/virginia/management_and_managerial/485331021/e/

 
 

 
 

Overview

The Medical Director – Centennial Care will join an established team that is shaping the future of Presbyterian’s Medicaid plan and the evolution of the State of New Mexico’s Medicaid program.
Presbyterian Health Plan – Presbyterian Healthcare Services’ insurance entity – includes Medicaid and Medicare insurance plans, as well as multiple commercial options. The Medicaid plan – Presbyterian Centennial Care – currently serves more than 300,000 of New Mexico’s Medicaid members. New Mexico named the program “Centennial Care” in 2012 to honor one hundred years of statehood.
The scale and diversity of the Medicaid population affords unusual opportunities to effect change. Presbyterian leadership work one-on-one with New Mexico HSD personnel who are very open to initiatives, pilot programs, etc. that align with Centennial Care goals.

The following list highlights the opportunities this position offers for professional, cultural, and personal growth:

• Play an integral role within a fully integrated healthcare system.
• Break new ground in medical cost management and population health management.
• Support development and revisions to Medical Policies.
• Assist in initiatives to ensure accessibility of quality, affordable care and coverage for PHPs customers and members.
• Provide clinical leadership and promote best practices across the Presbyterian organization.
• Manage relationships with providers across the state.
• Support population health efforts, including a large population of vulnerable individuals in achieving their best health.
• Support New Mexico in improving the health of its population.
• Provide guidance and support for forward-thinking quality improvement initiatives.
  
  

Responsibilities

The Centennial Care Medical Director reports to the Presbyterian Health Plan (PHP) Senior Medical Director. S/he will be primarily responsible for performing medical necessity determinations in partnership with PHPs Utilization Management. The Medical Director is responsible for ensuring medical protocols and practice guidelines. This includes utilization management of health care services primarily with the prior authorization staff, participation in formulating complex care coordination, as well as peer-to-peer discussions with community clinicians. The Medical Director will also provide medical oversight, expertise, and leadership to ensure the delivery of cost-effective, quality healthcare services PHP members.

• Leads ongoing identification, design, and development of clinical practice guidelines/disease management pathways, incorporating both national standards and local physician input.
• Provides leadership in the education of members, providers, and PHS entities in the principles of coordination of care and utilization/resource/cost management, particularly as this relates to PHP.
• Primary responsibility for and direction of PHP utilization management activities, including direction and support for nurses in prior authorization, concurrent and retrospective review, referral coordination, and case management activities.
• Maintains effective liaison with provider groups in order to foster open communication and engender a collegial atmosphere in working toward a common goal: quality, cost effective health care.
• Assists in identifying and addressing examples of inordinate variation in patterns of utilization, and guiding staff and providers to effective resolution.
• Participates in development and implementation of an outcomes-oriented PHP Quality Management Program.
• Assists in the development of strategic plans for addressing resource management concerns and opportunities.
• Supports Delegated Groups through collegial educational efforts and facilitation of communication with these groups.
• Monitors and assists in the implementation of a quality, cost effective pharmacy program.
• Participates in all appropriate committee activities within the Quality committee structure.
• Participates in relevant strategic and benefit planning sessions.
• Insures compliance with HCFA, HSD, DOI and all other regulatory agencies.
• Supports PHP in achieving and maintaining NCQA, HCFA, IPRO and all other accrediting requirements.
• Helps to ensure the implementation of an effective information system which is relevant in measuring both quality and utilization outcomes.
• Supports efforts of PHP in developing and distributing a severity-adjusted Physician Practice Profile.
• Supports PHS-wide Health management activities designed to improve the health of those individuals, families, and communities we serve.
• Performs other functions as required.
  
  

Qualifications

• M.D. or D.O. degree, with board certification
  
  
• Five years of clinical practice experience
  
  
• Currently licensed to practice without restriction
• Experience in a managed care setting strongly preferred
  
  
• Experience in use of application of evidence-based clinical practice guidelines and resource, utilization, and cost management initiatives.
• Requires detailed knowledge of medical management principles, including utilization management, case management, retrospective and concurrent review, and prior authorization, in terms of theories and practices both directly and to serve as the resource or educator to other practitioners.
• Understanding of managed care environment.
  Experience with Medicare, Medicaid and state programs desirable. Familiarity with National Committee for Quality Assurance (NCQA) and with Health Plan Employer Data and Information Set (HEDIS) principles and requirements desirable.
  
  

Benefits

Benefits are effective day-one (for .45 FTE and above) and include:

• Competitive salaries
• Full medical, dental and vision insurance
• Flexible spending accounts (FSAs)
• Free wellness programs
• Paid time off (PTO)
• Retirement plans, including matching employer contributions
• Continuing education and career development opportunities
• Life insurance and short/long term disability programs
  
  

About Us

Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state’s largest private employer with approximately 14,000 employees.
Presbyterian’s story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.
We are part of New Mexico’s history – and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico

New Mexico’s unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque’s International Balloon Fiesta, Los Alamos’ nuclear scientists, Roswell’s visitors from outer space, and Santa Fe’s artists, and you get an eclectic mix of people, places and experiences that make this state great.
Cities in New Mexico are continually ranked among the nation’s best places to work and live by Forbes magazine, Kiplinger’s Personal Finance, and other corporate and government relocation managers like Worldwide ERC.
New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it’s all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses
#JB123

 
 

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Description:

Job Description
The Dental, Vision Voluntary Growth Strategy Lead will grasp marketing, client relationships and sales in a holistic way to leverage all tools, techniques, and their expertise for growth in Medicare/Medicaid (sales or client relations) to accomplish our strategic growth goals. Responsibility for driving year over year growth across all products.

Required Qualifications
– Drives the cross functional coordination deepen penetration and increase cross sell opportunities and reduce non-value-added activities encumbering growth initiatives.
– Collaborates with Medicare, Medicaid and network teams on the annual growth planning process , driving and developing long-range strategic plans, objectives, and tactics for our client portfolio’s while ensuring alignment & inclusion of our company’s aspirations to introduce new and innovative products.
– Participates in the development of marketing/sales strategies and processes, liaising with key stakeholders.
– Cultivates long term key stakeholder prospect relationships and positions our company as optimal solution before and when an opportunity develops.
– Provide strategic direction, leadership and support to sales and service staff and consultative services to customers to achieve sales, service and retention goals.
– Formulates strategic decisions by bridging insights (data) and product strategies to guide creative direction for increased revenue and client loyalty.
– Develops actionable strategies, and dashboards to gain a competitive advantage and determine best means to communicate and collaborate with existing clients.
– Anticipates and identifies challenges and builds solutions.

Preferred Qualifications
– 7-10 years of experience in Business Development, direct sales or Client Management Leadership.
– Proven experience leading transformational change in a competitive consumer product market.
– Demonstrate ability to define and deliver on growth strategy and distribution channel optimization across multiple geographies.
– Demonstrate superior analytical, quantitative and problem-solving skills.
– Ability to develop and execute strategy
– Ability to turn quantitative and qualitative data insights into actionable marketing recommendations and able to tell the story.
– Track record of success driving outcomes across an organization with multiple stakeholders.
– Strong affinity understanding of target audiences, needs and sales management.
– Builds credibility and trust across the organization to drive change by challenging conventional thinking.
– Client facing role

Education
Bachelor’s degree or equivalent work experience

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.

20 hours ago

 
 

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Medicaid/Medicare Srvs Specialist III

Pay Grade 15

Salary $3,230.84 Monthly

Employment Type

EXECUTIVE BRANCH | FULL TIME, ELIGIBLE FOR OVERTIME PAY | 18A | 37.5 HR/WK

Hiring Agency

Cabinet for Health & Family Services | Department for Medicaid Services

Location

275 East Main Street, 6W-B

Frankfort, KY 40621 USA

The agency may authorize the selected candidate to telecommute. The candidate may need to report to the office as needed. The agency may terminate or modify the telecommuting arrangement at any time.

Description

The Department for Medicaid Services (DMS), Division of Community Alternatives, Home and Community Based Services Branch provides services and support to elderly people and/or children to remain in or return to their homes provided through waiver programs. This opportunity will allow an individual to continue career growth by learning the various deliveries of waiver services through person directed services (PDS) and traditional agencies providing services to our waiver participants served under the Home and Community Services Branch. The agency may authorize the selected candidate to telecommute. The candidate may need to report to the office as needed. The agency may terminate or modify the telecommuting arrangement at any time.

The candidate will assist both participants, providers and other agencies by identify and resolving routine program issues. As well as conducting audits, monitoring and analyze trends and patterns identifying program deficiencies. Perform duties including but not limited to completing tasks the Medicaid Waiver Management Application (MWMA), Medicaid Management Information System (MMIS) and Benefind. Research complex issues related to Centers for Medicare and Medicaid Services (CMS), Cabinet for Health and Family Services and within the Department for Medicaid Services. Performs audits and program monitoring from the office, as well as provider locations to determine CMS/DMS program compliance. Represents the division and branch in meetings and reports information obtained to management.

Preferred Skills

• Proficient at Microsoft Office products.
• Preferred candidate will have experience in Medicaid or Medicare policy or other related health insurance administration/systems health care research, health care financial management, health care policy
• Willing to work as a team
• Excellent communication skills ability to critically think
  
  

Minimum Requirements


EDUCATION: Graduate of a college or university with a bachelor’s degree.


EXPERIENCE, TRAINING, OR SKILLS: Four years of experience in Medicaid or Medicare program administration, health insurance administration/systems, eligibility systems, health care research, health care planning, health care financial management, health care policy development, human service or health care administration, insurance billing and/or claims, or research, review, and analysis of legislation or regulations.


Substitute EDUCATION for EXPERIENCE: NONE


Substitute EXPERIENCE for EDUCATION: Experience in the above areas will substitute for the required college on a year-for-year basis. Current or prior military experience will substitute for the required college on a year for year basis. Prior military experience will only substitute if the individual received an honorable discharge, discharge under honorable conditions, or a general discharge.


SPECIAL REQUIREMENTS (AGE, LICENSURE, REGULATION, ETC.): NONE


Working Conditions


Incumbents working in this job title primarily perform duties in an office setting.


Probationary Period


This job has an initial and promotional probationary period of 6 months, except as provided in KRS 18A.111.


If you have questions about this advertisement, please contact April Lowery at April.Lowery@ky.gov.


An Equal Opportunity Employer M/F/D

 
 

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Description:

Job Description
This position is responsible for actuarial support of the Louisiana Medicaid market, including pricing evaluation, reserving, forecasting and other analytical support as necessary. The actuarial team works closely with other functional areas, including Finance, Operations, Medical Management and Plan management.

#AetnaActuary

Required Qualifications
Existing proficiency with Microsoft Word, Excel Demonstrated analytical and computing skills. Demonstrated initiative and perseverance Excellent oral and written communications skills.

Preferred Qualifications
We are looking for individuals interested in pursuing their ASA/FSA designation(s). Progress in the exams towards the ASA designation.

Education
Degree in Actuarial Science / Statistics / Mathematics, or in Computer Science / Economics / Business / Finance / Physics / Engineering with a strong math background.

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.

21 hours ago

 
 

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About NYC Health + Hospitals

MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview
Reporting to the Head of Product, the Director of Medicaid ensures operational excellence and regulatory compliance of all Medicaid products, owning the full spectrum of product strategy and operations. The Director will support key analytical activities to support the Plan’s strategic position, and will be proactive in identifying opportunities for performance improvement.

Job Description

* Provide oversight of Plan and vendor operations as they relate to the Medicaid line of business aligning outcomes to strategic goals & regulatory requirements.
* Develop & manage operational reports to track operational effectiveness.
* Partner with operational departments including Claims, Customer Service, Finance, Enrollment, Vendor Management, & Medical Management to design processes ensuring effective & efficient operations.
* Support key stakeholders in driving initiatives to meet quality & customer satisfaction goals.
* Maintain customer focus throughout Plan operations to ensure a seamless & excellent customer experience.
* Provide deep knowledge of & insight into the regulatory & market environment of Medicaid in New York to support the development of product strategy.
* Identify & integrate operational best practices, partnering with key departments to optimize processes across the organization such as benefits administration, risk adjustment, marketing & communications, customer experience.
* Monitor & analyze regulatory activity ensuring compliant operations & implementation.
* Perform competitive & market analysis.
* Partner with internal & external stakeholders on key strategic, regulatory, & operational projects.

Minimum Qualifications

* Bachelor’s degree from an accredited college or university in an appropriate discipline required.
* Master’s degree in business, healthcare or public administration strongly preferred.
* Minimum 5 years experience at a Health Plan with Medicaid Managed Care in a product management or compliance role.
* Thorough knowledge of Medicaid regulatory environment in NYS.
* Experience working with NYS enrollment transactions & encounter data submissions.
* Thorough understanding of interconnected managed care operations
* Demonstrated ability to develop workflows, policies, procedures.
* Demonstrated ability to identify opportunities for improvement & implement solutions.
* Excellent written & verbal communication skills.
* Excellent analytical skills demonstrated by an ability to use actionable data to support decisionmaking, and to proactively identify opportunities.
* Highly collaborative, and demonstrating good judgment in seeking consensus & input from multiple stakeholders to drive decision-making.
* Ability to take initiative & think independently
* Demonstrate understanding & acceptance of the MetroPlus Mission, Vision, & Values

Professional Competencies

* Leadership
* Results-driven
* Business acumen
* Systems orientation
* Process improvement
* Data-driven decision-making
* Customer focus
* Written/oral communication
* Resourcefulness
* Ability to work effectively in a fast-paced & constantly evolving environment

 
 

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Description


The Associate Director, Medicaid Implementation (Project Management) manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Associate Director, Medicaid Implementation (Project Management) requires a solid understanding of how organization capabilities interrelate across department(s).


Responsibilities


The Associate Director, Medicaid Implementation (Project Management) develops and maintains a Medicaid Implementation Project Management Office (MPMO). Responsible for the strategic and operational oversight of multiple projects to support business objectives through project planning and implementation. Responsible for project management methodology and standard reporting.

• Leads large scale and complex projects and initiatives throughout across the entire enterprise.
• Provides leadership and oversight of the business unit’s entire implementation processes; managing company adherence to standard implementation processes for both Business and IT.
• Manages project staff involved in the planning, development and implementations.
• Manages business and program implementations to meet budget, timeline, and contractual requirements.
• Maintains standard business implementation organizational structures, team structures, work breakdown structures, work planning, issue logs, decision logs, change control and executive reports.
• Provides input on operating models, including standard corporate functional and information system models, performance metrics, expected outcomes and plan impacts.
• Coordinates enterprise wide cross-functional tasks between various internal and external areas to ensure successful project outcomes.
• Communicates project status to all internal and external stakeholders.
• Mentors project team members and stakeholders using appropriate tools and techniques in order to increase and maintain commitment to portfolio objectives.
• Identifies and reduce redundancies among projects when necessary.
• Leads change management activities.
• Identifies and develop contingency plans to mitigate and address risks.
• Sets the pace and manage the cadence of Medicaid Implementation activities.
• Acts as the Humana point of contact for implementation activities with the government partners during the implementation.
• Supports Market leadership in delivering the contractual obligations required under the State Medicaid RFP/Contract.
  
  
   

Required Qualifications

• Bachelor’s Degree or equivalent experiences.
• Five (5) or more years of technical and/or business project management experience.
• Two (2) or more years of leadership experience.
• Must have a room in your home designated as a home office; away from high traffic areas where confidential information may be secured.
• Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required.
• Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
  
  
   

Preferred Qualifications

• Knowledge of Systems Development Life Cycle, Waterfall, and Agile Development Methodologies.
• Possess a solid understanding of operations, technology, communications and processes.
• Proficiency in Microsoft Office programs.
• Experience working in Medicaid and/or Medicare.
• Possess a solid understanding of operations, technology, communications and processes.
• Six Sigma and / or Project Management Institute certification.
  
  
   

Additional Information

• Travel: up to 25% to various states.
• Direct Reports: up to 12 associates.
• Work Days/Hours: Monday – Friday; Eastern Time Zone.
• The following policy applies ONLY to associates working in the state of Arizona: Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective July 1, 2011, Humana adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.
  
  
   

Interview Format


As part of our hiring process, we will be using an exciting interviewing technology provided by Montage/Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.


If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.


If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.


Scheduled Weekly Hours


40

 
 

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Job Description

• Manages and builds a strong team of health care analysts through leadership and mentoring, holding primary responsibility for delivery of analysis projects to successfully provide tactical and strategic solutions to constituent needs.
• Collaborates with business partners to provide sound advice on projects and programs.
• Deep knowledge of health care data, metrics, systems and advanced research methods.
• Responsible for ensuring appropriate review and sign-off of project results to ensure appropriate use of study results.
• Leads interdepartmental teams to shape policy and process.
• Performs or manages custom analysis of integrated healthcare data, interprets results, and makes recommendations based on analytic findings to business areas.
• Makes recommendations about data collection methods, metrics definition and evaluation methods.
• Stays informed about industry trends, research findings, and evaluation methods.
• Recommends and develops tactical and strategic solutions that satisfy information needs across products, segments and clients.
• Presents analytic reports to clients and stakeholders, presents and explains results effectively to non-technical audiences.
• Participates in the development of project plans and timelines.
• Manages team projects, people, customer expectations and business priorities to achieve constituent satisfaction. -Integrates understanding of internal and external data sources for quantifying risks.
• Responsible for team commitments to quality and on-time deliverables.
• Is willing to understand and probe into technical details and mentors his/her direct reports to do the same.
  
  

Required Qualifications

• Excellent analytic and problem solving skills.
• Strong reporting skills using excel, access, word and/or PowerPoint.
• Project management and/or team leading experience.
• Demonstrated leadership ability.
• Strong communication and collaboration skills.
• QuickBase building and maintaining.
  
  

Preferred Qualifications

• Healthcare provider data experience.
• QNXT and EPDB system experience.
• Strong SQL and SASS skills.
• Medicaid State Request for Proposal experience.
  
  

Education

Bachelor’s degree or higher.

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.

 

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