AETNA CAREERS
Careers webpage
Account Client Manager (New York Territory, Medical & Life License Required)
Requisition # 35734BR
POSITION SUMMARY
The primary function of this role is to manage a Small Group book of business,
and achieve set retention goals, and company initiatives/targets for this size
segment. The book of business is comprised of customers located in the
Northeast and Mid-Atlantic territories, with medical, dental, vision, life and/or
disability coverage.
FUNDAMENTAL COMPONENTS:
Manage assigned book of business of roughly 1000 SG accounts, 1-50 lives;
internal position.
Strong written and verbal communication skills.
Strong and proven sales skills, preferably in working with third parties such as
brokers, general agents and third party administrators. Able to sell over the
phone and in writing vs. in person.
Highly organized and efficient, able to handle high volume.
Strong collaboration skills, able to work both independently and with a team
toward common goals.
Fast typing skills of 70 WPM or greater, strong background in all MS Office
products, particularly MS Outlook, Excel and Word. Powerpoint skills would be an
additional bonus.
Flexible and positive.
BACKGROUND/EXPERIENCE desired:
3-5 year relevant experience.
Strong account management and sales orientation.
Bachelor's degree or equivalent work experience required
ACS Market Head of Sales and Distribution
Requisition # 35255BR
POSITION SUMMERY:
Be able to develop and manage distribution initiatives and tools,
articulate the value of Aetna Whole Health to internal and external
audiences and help develop enterprise expertise needed to drive
sustainable Aetna Whole Health membership growth across multiple
channels.
FUNDAMENTAL COMPONENTS:
-Ability to articulate specifics of AWH strategy and value proposition,
assigned ACO strategy/value story to C-Suite personnel representing all
segments as well as leading consultants in the markets.
-Ability to describe claim target setting and reconciliation methodologies
to consultants and plan sponsors.
-May represent Aetna Whole Health in client meetings, communicating
the value proposition for a specific client, and help Aetnas sales teams
understand the value for their clients
-Ability to strategize with territory Presidents and local sales leadership to
best position Aetna Whole Health Development in the assigned
geographies.
-Partner with local ACO leadership to develop a tactical strategy to lead
generation allowing us to leverage our ACOs to grow membership.
-Provide strategic guidance to the Engagement teams that will best allow
ACS to navigate a dynamic market.
-Work with ACS Underwriting and Actuarial to proactively position AWH
with the local underwriting teams.
-Develop methodologies in conjunction with enterprise underwriting that
will allow for increased membership into AWH.
-Documents and manages strategies and plans that result in Aetna Whole
Health membership growth.
-Identifies gaps and recommends enhancements related to new and/or
existing channels, offerings, tools and workflows.
-May organize and/or facilitate meetings and presentations influencing
various internal (these may be cross-functional/segment) and external
audiences (e.g., plan sponsors, brokers, ACOs).
-Determines the sales capability and effectiveness of existing and potential
distribution initiatives and channels.
-Develops tools and resources (or recommends investments) for successful
execution of distribution channels and initiatives.
-Articulates business strategies to distribution partners to gain
commitment.
-Works with distribution partners to analyze and help close production
gaps.
-Oversees and/or coordinates work with staff outside own area to ensure
effective execution of distribution channel objective.
-Cultivates and maintains strong, influential relationships with all internal
and external constituents
-Maintains an inventory of products, markets, opportunities and issues for
each distribution channel and ACO within area of responsibility.
BACKGROUND/EXPERIENCE desired:
At least 10 years of industry sales experience.
At least 5 years of sales management experience.
EDUCATION:
The highest level of education desired for candidates in this position is a
Bachelor's degree or equivalent experience.
Appeals Nurse Consultant (Medicare Advantage)
Requisition # 35751BR
Case Management Coord
Requisition # 35787BR
POSITION SUMMARY:
The Care Manager Coordinator will perform various computer-based
assessments on LTSS members, and provide care management and care
coordination in order to meet that member's needs. She or he will manage the
field work and office documentation from the home office.
Fundamental Components:
-Care manager who enjoys meeting members where they live, to assess needs
and provide services to meet those needs. -Manage weighted caseload of under
120 members who meet Nursing Facility Level of Care. -Management includes
completion of NJ Choice assessment, additional computer documentation, and
authorization of specific services to help members remain in the community as
long as possible. -Work with a supportive team in CMs general geographical area,
and with transportation reimbursement. -Additional focus on creating and
updating authorizations, processing faxed requests for service authorization, for
CM team, as assigned.
BACKGROUND/EXPERIENCE:
-Certification in NJ Choice assessment preferred - 3-5 years clinical practice
experience, e.g., hospital setting, alternative care setting such as home health,
PCA agency, or NJ DMAHS or MCO Care Management background. -Case
management and discharge planning experience preferred -Managed Care
experience preferred -Self-starter and good time management skills a must
EDUCATION:
The highest level of education desired for candidates in this position is a
Bachelor's degree or equivalent experience.
DESIRED SKILLS:
Benefits Management/Understanding Clinical Impacts/FOUNDATION
General Business/Communicating for Impact/FOUNDATION
TELEWORK SPECIFICATIONS:
Flexible telework / office-based schedule with at least 4 weeks in office for
training, then bimonthly in-office meetings. Otherwise work from home office.
Case Manager
Requisition # 33834BR
Case Manager (RN)
Requisition # 35380BR
POSITION SUMMARY
This role will strive to positively influence the practices overall
patient health outcomes through achieving favorable patient
outcomes measured by clinical quality and utilization measures.
With a focus on delivering comprehensive, patient-centered care
across the health care continuum, the case manager will work
closely with physician practices to deliver daily care coordination,
chronic care management, coaching, consultation and
intervention with a particular focus on patients with complex
health care needs. This position will require up to 75% travel in a
local radius.
FUNDAMENTAL COMPONENTS:
Leveraging technology, and working closely as part of a provider,
interdisciplinary care team, the case manager will:
--Identify complex, high-risk patients and proactively manage care
including but not limited to care management planning, referral
management, post-discharge planning, and coordinating
transitional and community based care.
--Through the use of a clinical decision support system, the patient
population will be monitored and managed, including the
identification and risk stratification of complex, co-morbid
patients, with the objective of focusing case management efforts
on the segment of the population requiring the highest degree of
support.
--Provide a patient-centered, interdisciplinary approach to health
care and care coordination using comprehensive, evidencedbased care plans developed in concert with the patient/care giver
and with the support of the provider.
--Cultivates a strong, cohesive, team-oriented relationship with
practice partners, including on-site and remote interaction where
appropriate, whereby the practices care team considers the case
manager as an extension of and integral part of the practices care
delivery program.
--Screens patients and conducts individualized clinical
assessments of patients’ health concerns/needs; support the
patient in developing personalized condition-specific action plans,
provides appropriate education, monitoring and appropriate care
management program referrals.
--Evaluates the patients progress in setting and meeting
established goals and revises their individualized care plan
accordingly.
--As appropriate, performs transitions in care assessments for
patients discharged from an in-patient hospital or skilled nursing
facility.
--Medication reconciliation in supporting patient medication
management, particularly as it relates to the post-discharge
planning process in support of medication compliance, and
treatment adherence.
--Advocates, guides and intervenes on behalf of patients, their
family and/or care givers, in concert with the PCP, in
understanding and navigating the health care system, including
the coordination of community resources.
--Defines, evaluates and reports on desired and actual patient
health outcomes in collaboration with the interdisciplinary care
team.
--In urgent and non-emergency situations, facilitates the
escalation of high-priority, problem patient cases that require
direct and/or immediate intervention by the physician care team
BACKGROUND/EXPERIENCE:
--Active and unrestricted Nursing/Registered Nurse (RN) License
--Minimum of 3-5 years of current clinical experience in a patient
case management position such as CM, DM case worker, and
other relevant roles
--Strong professional level knowledge of comprehensive clinical
assessment skills in the adult population and experience with
chronic diseases.
EDUCATION:
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Active and Unrestricted Registered Nurse (RN) is
required.
Nursing/Certified Case Manager (CCM) is desired.
Experience in Provider practice preferred.
TELEWORK SPECIFICATIONS:
Phoenix, AZ area only.
Case Manager (RN) - 100% Virtual (heavy local travel)
Requisition # 35830BR
POSITION SUMMARY
The nurse (RN) case manager is a clinical leader focusing on
integrating member care, clinical coordination, leading the
development, implementation and ongoing monitoring of
program and quality initiatives to address the needs of Aetna
members. The RN is embedded in the local market and assigned
to specific provider practices, with local travel to patient homes
and physician offices in Essex, Morris, and Union, and surrounding
counties in New Jersey.
FUNDAMENTAL COMPONENTS:
The RN will have the following overall responsibilities
-Move a small, complex patient population to an optimal state of
health & wellness
-Focus on integrating patient care, enhancing clinical coordination,
and implementing quality initiatives to address patient needs
-Collaborate effectively with physician groups, community
organizations, & local nurses to enhance clinical efficiencies &
quality outcomes for Aetna members.
-Engage providers and patients both at a physician’s office and in
the members’ home.
-Proficiently utilize care coordination & plan benefit platforms to
maximize patient engagement and seamless integration within
the ACO.
-Work with the provider interdisciplinary care team to proactively
manage care including care management planning, referral
management, and post-discharge planning.
-Help coordinate transitional and community based care &
provide chronic care management, coaching, consultation &
intervention for patients with diabetes or hypertension.
JOB RESPONSIBILITIES:
-Identify, screen & assess patient needs, both in person &
telephonically - Conduct patient health assessments; develop
personalized condition-specific action plans; reinforce education
and monitoring
-Educate the patient about their medical condition, and selfmanagement of the chronic disease(s)
-Identify opportunities for health services, modifiable risk factors
& educational needs; provide appropriate partner referrals
-Intervene to positively affect patient healthcare outcomes
-Apply behavior modification techniques to drive patient
empowerment to understand & holistically manage all aspects of
their healthcare needs
-Equip patients so that they are informed & actively engaged with
their provider in making the best health care decisions
-Evaluate the patient's progress in setting/meeting goals; revise
care plan accordingly
-Work in a team environment to include case transfer to
telephonic case management
-Promote quality, cost effective outcomes; improve
program/operational efficiency. Identifies & escalates quality of
care issues through established channels
-Sets expectation of Member Activation as a goal for each
member
-Evaluates member progress in setting/meeting established goals;
revises care plan accordingly
-Create meaningful, comprehensive & clear documentations,
including online records
BACKGROUND/EXPERIENCE desired:
Required:
Direct patient clinical care experience in the past 5 years
Local travel
Disease & Case Management or Managed Care
Interact with members on phone & in person
Flexibility to changing processes and schedule
Clinical critical thinking skills
Preferred:
Diabetes & Hypertension
Clinical assessment
Aetna Medical Management Systems
Bilingual
EDUCATION
The highest level of education desired for candidates in this
position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is desired
FUNCTIONAL EXPERIENCES
-Functional - Nursing/Case Management/4-6 Years
-Functional - Nursing/Disease management/4-6 Years
-Functional - Nursing/Concurrent Review/discharge planning/4-6
Years
-Functional - Management/Management - Health Care Delivery/46 Years
-Functional - Clinical / Medical/Direct patient care (hospital,
private practice)/4-6 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Word/7-10 Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/7-10 Years/End
User
Technical - Desktop Tools/Microsoft Outlook/7-10 Years/End User
REQUIRED SKILLS
Benefits Management/Maximizing Healthcare
Quality/FOUNDATION
Benefits Management/Supporting Medical Practice/FOUNDATION
Benefits Management/Understanding Clinical
Impacts/FOUNDATION
DESIRED SKILLS
Leadership/Driving a Culture of Compliance/FOUNDATION
Service/Providing Solutions to Constituent Needs/ADVANCED
TELEWORK SPECIFICATIONS:
Technically full time telework, the nurse will work primarily from
physician offices in Essex, Morris, and Union Counties in New
Jersey, and make member home visits in the same area as well.
There may be travel required to Middlesex, Somerset, Passaic,
and Sussex counties and surrounding areas.
Client Solutions Strategic Account Director
Requisition # 31970BR
POSITION SUMMARY
The Account Director is accountable to develop long term client
management strategies for larger and more complex clients (>300
employees) to meet profitable growth and cross-selling
objectives. The Account Directors primary focus is to act as a
senior strategic business partner to our clients and broker
partners and to achieve retention and growth objectives year over
year.
FUNDAMENTAL COMPONENTS:
Develop deep understanding of each customers business
objectives Analyze client utilization data to understand cost
drivers and develop health plan strategy to reduce costs over time
Educate client on regulatory issues and developing healthcare
trends that could potentially impact their plan Using available
resources, complete complex analyses to aid in financial decision
making and plan recommendations Identify and present cross-sell
opportunities Maintain excellent verbal and written
communication skills and lead client interactions with C-Suite
decision makers Assess and understand competitive environment
and market opportunities Establish and maintain relationships
with appropriate internal partners (underwriting, sales,
operations, business analytics, etc) Develop retention and growth
forecast and deliver results Participate in finalist presentations as
appropriate Handle complex contract negotiation and leverage
available resources Maintain strong field presence Supervisory
responsibilities of designated Account Manger
BACKGROUND/EXPERIENCE desired:
8-10 Years of industry experience Strong understanding of selffunded industry Strong understanding of health plan design and
products Strong negotiation, strategy, and forecasting
skills. Licensure as required by State (requires Life, Accident, and
Health Insurance licensure for the state correlated to residence).
College degree or equivalent work experience
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Sales & Service/Account Management/7-10 Years
Functional - Administration / Operations/Travel/1-3 Years
Functional - Clinical / Medical/Consultative informatics/1-3 Years
Functional - Finance/Financial Forecasting/1-3 Years
Functional - Underwriting/Renewal - group medical/1-3 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End
User
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Remote Access/WAH (Work at Home)/1-3 Years/End
User
Clinical Care Manager
Requisition # 35789BR
POSITION SUMMARY
The Clinical Care Manager is a NJ licensed Registered Nurse who
will perform various computer-based assessments on LTSS
members, and provide care management and care coordination in
order to meet that member's needs. She or he will manage the
field work and office documentation and authorizations from the
home office.
FUNDAMENTAL COMPONENTS:
Nurse care manager who enjoys meeting members where they
live, to assess needs and provide services to meet those needs.
Manage weighted caseload of under 120 members who meet
Nursing Facility Level of Care. Management includes completion
of NJ Choice assessment and Personal Care Assistant assessment,
additional computer documentation, and authorization of specific
services to help members remain in the community as long as
possible. Work with a supportive team in CMs general
geographical area, and with transportation reimbursement.
BACKGROUND/EXPERIENCE:
NJ licensed RN required
Certification in NJ Choice assessment preferred
3-5 years clinical practice experience, e.g., hospital setting,
alternative care setting such as home health, PCA agency, or NJ
DMAHS or MCO Care Management background.
Case management and discharge planning experience preferred
Managed Care experience preferred
Crisis intervention skills preferred
EDUCATION
The highest level of education desired for candidates in this
position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is required
Telework Specifications:
Full-Time Telework (WAH) following 3-4 week orientation in
Princeton office. Once or twice monthly in office requirements for
meetings.
Clinical Supervisor - RN
Requisition # 35368BR
POSITION SUMMARY
With a focus on delivering comprehensive, patient-centered care
across the health care continuum, the Clinical Supervisor is
responsible for oversight of the Multidisciplinary Care team
including the organization and development of a high performing
team. Works closely with manager to ensure consistency in clinical
interventions supporting our members and is accountable for
meeting the financial, operational and quality objectives of the
JV.. He or she will develop, implement, support, and promote
strategies, tactics, policies, and programs that integrate with
Providers to drive the delivery of quality healthcare and establish
competitive business advantage for the JV.
FUNDAMENTAL COMPONENTS:
Oversees the management of the Interdisciplinary team for
assigned area
Participates in the recruitment, hiring and development of the
Multidisciplinary Care team which includes Care Managers, Social
Workers and Diabetic Educators
Assesses team developmental needs and collaborates with others
to identify and implement action plans that support the
development of high performing teams
Implements clinical policies & procedures in accordance with
applicable regulatory and accreditation standards (e.g. NCQA,
URAC, state and federal standards and mandates as applicable)
Serve as a content model expert and mentor to the team
regarding practice standards, quality of interventions, problem
resolution and critical thinking
Collaborates with Provider Practices to assure successful
integration of the Multidisciplinary Care Team
Ensure implementation and monitoring of best practice
approaches and innovations to better address the member's
needs across the continuum of care
Ability to evaluate and interpret data, identify areas of
improvement, and focus on interventions to improve outcomes
May develop/assist in development and/review new training
content
Protects the confidentiality of member information and adheres
to company policies regarding confidentiality
May act as a single point of contact for the JV and the Clinical
Transformation Team including: participation in meetings as
required
Establish an environment and work style that promotes the
concept of teamwork, integration, and continuum of care thinking
that results in strong performance
Consistently demonstrates the ability to serve as a model change
agent and lead change efforts
Create a positive work environment by acknowledging team
contributions, soliciting input, and offering personal assistance,
when needed
BACKGROUND/EXPERIENCE :
Active and unrestricted Nursing/Registered Nurse (RN) License
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Nursing/Certified Case Manager (CCM) is desired
Coding Quality Auditor
Requisition # 34624BR
There is potential for work at home, but candidates need to be
able to commute around Fairfax, VA.
Aetna is currently seeking a Coding Auditor to join our team. The
Coding Auditor will be responsible for perform audits of medical
records and ensuring the ICD-9 codes are appropriate and
accurate. The Coding Auditor will also be responsible for providing
recommendations on how quality goals can be met or exceeded.
Responsibilities of the Coding Auditor:
Perform audits of medical records to ensure all assigned ICD-9
codes are accurate and supported by written clinical
documentation
Provide education to staff and providers on audit findings and ICD9 codes
Provide recommendations for process improvement
Maintain knowledge of ICD-9 codes, CMS documentation
requirements, and state/federal regulations
Required Qualifications of the Coding Auditor:
A minimum of two years of medical record review, coding, or
auditing experience
CPC (Certified Professional Coder) or CCS-P (Certified Coding
Specialist-Physician)
Experience with ICD-9 codes
Experience with Medicare Risk Adjustment process
Experience with Excel functions such as Pivot Tables V-LOOKUPS
Education of the Coding Auditor:
High School diploma, G.E.D. or equivalent experience
Benefits
AETNA offers competitive benefits including options and choices
to fit your needs such as medical, dental, life insurance, long and
short term disability, matching 401k plan, employee stock
program, and also tuition assistance.
Requisition # 36010BR
POSITION SUMMARY
Responsible for performing audits of medical records to ensure
the ICD-9/ICD-10 codes that are submitted to the Centers for
Medicare and Medicaid Services (CMS) for the Risk Adjustment
Payment System (RAPS) are appropriate, accurate, and supported
by written clinical documentation in accordance with all state and
federal regulations and internal policies and procedures.
FUNDAMENTAL COMPONENTS:
Responsible for conducting provider ICD-9/ICD-10 coding audits
Responsible for retrieving medical records and validating HCC
submissions for internal data validation and CMS National and
Target audits. Responsible for ICD-9/ICD-10 coding for Provider
Education Program.
BACKGROUND/EXPERIENCE desired:
Minimum of 2 years recent and related experience in medical
record documentation review, diagnosis coding, and/or auditing.
CPC (Certified Professional Coder) or CCS-P (Certified Coding
Specialist-Physician) required
Experience with ICD9/ICD10 required.
Experience with Medicare and/or Medicaid Risk Adjustment
process required
Experience with Microsoft Office products (Word, Excel, Project)
EDUCATION
The highest level of education desired for candidates in this
position is a High School diploma, G.E.D. or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Clinical / Medical/Clinical claim review & coding/1-3
Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Word/1-3 Years/
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/
TELEWORK SPECIFICATIONS:
Full-Time Telework (WAH). Considered for any US location;
training period in the office may be required.
Contract Negotiator
Requisition # 35952BR
POSITION SUMMARY
Design, develop, contract, maintain and enhance relationships
with facilities, physicians and ancillary providers which
serve as contractual networks of care for members; foster growth
of managed care products; and enhance profitability of
Aetna.
Note: WORK AT HOME considered only for Greater
Minneapolis/St. Paul candidates
FUNDAMENTAL COMPONENTS
Accountable for all aspects of physician recruitment and
contracting as well as ad/hoc network contracting as
assigned
Responsible for re-negotiating or negotiating solo, complex group,
hospital-based and large entity physician contracts in support of
network quality, availability and financial goals
Participates in the strategic recruitment of physicians satisfying
specific network goals and objectives
Provides network development, maintenance and refinement
activities and strategies in support of cross-market
network management units
Partners across the organization to garner support for network
contracting activities to ensure all aspects of
operational implementation are completed on a timely and
accurate basis
May be responsible for supervising and mentoring staff
BACKGROUND/EXPERIENCE desired:
Communication Skills - Strong written and verbal communication
skills. Able to identify and capitalize on marketing
opportunities to support program delivery.
Mastery of provider contracts, contracting options, PADU
guidelines as well as provider configurations.
In-depth knowledge of the managed care industry and practices,
as well as a strong understanding of Aetna competitor strategies.
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
Diabetic Educator
Requisition # 35377BR
Dir, Network Management
Requisition # 35953BR
POSITION SUMMARY
Negotiates, competitive and complex contractual relationships
with providers according to pre-determined internal guidelines
and financial standards. Works cross-functionally to execute
network strategies. Maintains accountability for specific medical
cost initiatives. Manages local network management team.
Note: WORK AT HOME considered only for Minneapolis/St. Paul
residents
FUNDAMENTAL COMPONENTS:
Effectively negotiates complex, competitive contractual
relationships with providers according to prescribed guidelines in
support of national and regional network strategies
Manages provider compensation/reimbursement and pricing
development activities
Responsible for understanding and managing medical cost issues
and initiating appropriate action
Provides sales and marketing support, community relations and
guidance with comprehension of applicable federal and state
regulations
Assist and facilitate business intent reviews (BIR)
Initiate legal reviews as needed; ensure all required reviews
completed by appropriate functional areas
Regional owner of Strategic Contact Manager (SCM) and rate
wizard contracting
May supervise day-to-day operations of network management
teams/units
Assist with the design, development, management, and/or
implementation of strategic network configurations
Manages local Provider Relationship Management, Organization
Orientation, Provider Advocacy
BACKGROUND/EXPERIENCE desired:
Must possess a successful track record negotiating large hospital
system contracts.
Comprehensive understanding of hospital and physician financial
issues and how to leverage technology to achieve quality and cost
improvements for both payers and providers.
In-depth knowledge of managed care business
EDUCATION
The highest level of education desired for candidates in this
position is a Master's degree. MBA-Master's Preferred
Director Clinical Pharmacy Programs
Requisition # 35862BR
POSITION SUMMARY
Lead development of clinical programs that help drive plan
performance and cost containment. This position works with key
matrix partners such as actuary, analytics, formulary management
team etc. to develop clinical programs from concept to
implementation that optimize safe and effective medication
utilization, promote cost effective value based care, reduce FWA
and drive better clinical outcome. In addition, this individual leads
a large team of clinical pharmacists to help manage hospital
readmission prevention working closely with case management
and other clinical resources within medical management. Ideal
candidate would be someone who thinks strategically,
understands various stakeholders in the complex health care
system and has proven track record to develop and managed
clinical programs in a health plan or PBM. 3 years of previous
managed care experience required and Medicare experience
highly desired.
BACKGROUND/EXPERIENCE desired:
In-depth knowledge and experience in managed care / managed
pharmacy / competitive environment.
3 years clinical pharmacy experience or equivalent -- required
Medicare experience -- Required
Cost Saving initiative -- desired
Management experience - required
Strategic planning -- desired
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Pharmacy/Registered Pharmacist is required
FUNCTIONAL EXPERIENCES
Functional - Management/Management - Medicare/1-3 Years
Functional - Medical Management/Medical Management Pharmacy/1-3 Years
Functional - Clinical / Medical/General Management/1-3 Years
Functional - Project Management/Project Leader/1-3 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Project/1-3 Years/End User
REQUIRED SKILLS
General Business/Turning Data into Information/ADVANCED
Leadership/Collaborating for Results/ADVANCED
Leadership/Developing and Executing Strategy/ADVANCED
DESIRED SKILLS
Leadership/Creating a World Class Workforce/ADVANCED
Leadership/Driving Strategic and Organizational
Agility/ADVANCED
Leadership/Engaging and Developing People/ADVANCED
Engagement Manager
Requisition # 35688BR
Exec Dir, Architecture
Requisition # 33998BR
Field Case Manager - San Bernardino CA
Requisition # 35434BR
POSITION SUMMARY
Responsible for assessing and analyzing an injured employee to
evaluate the medical and vocational needs required to facilitate
the patients appropriate and timely return to work. Acts as a
liaison with patient/family, employer, provider(s), insurance
companies, and healthcare personnel.
FUNDAMENTAL COMPONENTS:
Assesses and analyzes an injured employees medical and
vocational status; develops a plan of care to facilitate the patients
appropriate and timely return to work.
Interviews patients in their homes, work-sites, or physicians office
to provide ongoing case management services.
Monitors patient progress toward desired outcomes through
assessment and evaluation.
Communicates both in-person and telephonically with patient,
medical providers, attorneys, employers and insurance carriers;
prepares all required documentation of case work activities.
May arrange referrals, consultations and therapeutic services for
patients; confers with specialists concerning course of care and
treatment.
Develops and administers educational and prevention programs.
Applies all laws and regulations that apply to the provision of
rehabilitation services; applies all special instructions required by
individual insurance carriers and referral sources.
Testifies as required to substantiate any relevant case work or
reports.
Daily travel in the field.
BACKGROUND/EXPERIENCE desired:
Registered Nurse (RN) with active state license in good standing in
the state where job duties are performed
Minimum 2 years clinical nursing background
Prior case management and workers' compensation experience
preferred
Ability to multitask in a fast paced work environment
Strong computer skills with experience in Microsoft Office
Products, including Word, Outlook, and Excel
EDUCATION
The highest level of education desired for candidates in this
position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) in CA is required
Nursing/Certified Case Manager (CCM) is desired
FUNCTIONAL EXPERIENCES
Functional - Nursing/Case Management/1-3 Years
Telework Specifications:
Full time WAH but with local travel in the field. Candidate needs
to reside in the San Bernardino, CA area.
Field Case Manager-Medical
Requisition # 35084BR
Field Case Mgr
Requisition # 32764BR
POSITION SUMMARY
Responsible for assessing and analyzing an injured employee to
evaluate the medical and vocational needs required to facilitate
the patients appropriate and timely return to work. Acts as a
liaison with patient/family, employer, provider(s), insurance
companies, and healthcare personnel.
FUNDAMENTAL COMPONENTS:
Assesses and analyzes an injured employees medical and
vocational status; develops a plan of care to facilitate the patients
appropriate and timely return to work.
Interviews patients in their homes, work-sites, or physicians office
to provide ongoing case management services.
Monitors patient progress toward desired outcomes through
assessment and evaluation.
Communicates both in-person and telephonically with patient,
medical providers, attorneys, employers and insurance carriers;
prepares all required documentation of case work activities.
May arrange referrals, consultations and therapeutic services for
patients; confers with specialists concerning course of care and
treatment.
Develops and administers educational and prevention programs.
Applies all laws and regulations that apply to the provision of
rehabilitation services; applies all special instructions required by
individual insurance carriers and referral sources.
Testifies as required to substantiate any relevant case work or
reports.
Daily travel in the field.
BACKGROUND/EXPERIENCE desired:
Registered Nurse (RN) with active state license in good standing in
the state where job duties are performed.
Minimum 2 years clinical nursing background
Prior case management and workers' compensation experience
preferred
Ability to multitask in a fast paced environment
Strong computer skills in Microsoft Office Products, including
Word, Outlook, and Excel
Excellent communication skills
EDUCATION
The highest level of education desired for candidates in this
position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) license is required in ID
Nursing/Certified Case Manager (CCM) is desired
TELEWORK SPECIFICATIONS:
Full time WAH but with daily travel in the field.
Field Case Mgr - Downey CA
Requisition # 32722BR
POSITION SUMMARY
Responsible for assessing and analyzing an injured employee to
evaluate the medical and vocational needs required to facilitate
the patient’s appropriate and timely return to work. Acts as a
liaison with patient/family, employer, provider(s), insurance
companies, and healthcare personnel.
FUNDAMENTAL COMPONENTS:
Assesses and analyzes an injured employees medical and
vocational status; develops a plan of care to facilitate the patients
appropriate and timely return to work.
Interviews patients in their homes, work-sites, or physicians office
to provide ongoing case management services.
Monitors patient progress toward desired outcomes through
assessment and evaluation.
Communicates both in-person and telephonically with patient,
medical providers, attorneys, employers and insurance carriers;
prepares all required documentation of case work activities.
May arrange referrals, consultations and therapeutic services for
patients; confers with specialists concerning course of care and
treatment.
Develops and administers educational and prevention programs.
Applies all laws and regulations that apply to the provision of
rehabilitation services; applies all special instructions required by
individual insurance carriers and referral sources.
Testifies as required to substantiate any relevant case work or
reports.
Daily travel in the field.
BACKGROUND/EXPERIENCE desired:
Minimum 2 years clinical nursing background
Prior case management and workers' compensation experience
preferred
Ability to multitask in a fast paced work environment
Strong computer skills with experience in Microsoft Office
Products, including Word, Outlook, and Excel
Excellent communication skills (written and verbal) with ability to
work automated files and use smart phone
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Nursing/Certified Case Manager (CCM) is desired
FUNCTIONAL EXPERIENCES
Functional - Nursing/Case Management/1-3 Years
TELEWORK SPECIFICATIONS:
Full Time WAH position with daily field travel. Candidate needs to
reside in the Downey, CA area or surrounding cities and be
Spanish Speaking.
Field Case Mgr - Greater Sacramento, CA
Requisition # 34193BR
POSITION SUMMARY
Responsible for assessing and analyzing an injured employee to
evaluate the medical and vocational needs required to
facilitate the patients appropriate and timely return to work. Acts
as a liaison with patient/family, employer, provider(s),
insurance companies, and healthcare personnel.
FUNDAMENTAL COMPONENTS:
Assesses and analyzes an injured employees medical and
vocational status; develops a plan of care to facilitate the patients
appropriate and timely return to work.
Interviews patients in their homes, work-sites, or physicians office
to provide ongoing case management services.
Monitors patient progress toward desired outcomes through
assessment and evaluation.
Communicates both in-person and telephonically with patient,
medical providers, attorneys, employers and insurance carriers;
prepares all required documentation of case work activities.
May arrange referrals, consultations and therapeutic services for
patients; confers with specialists concerning course of care and
treatment.
Develops and administers educational and prevention programs.
Applies all laws and regulations that apply to the provision of
rehabilitation services; applies all special instructions required by
individual insurance carriers and referral sources.
Testifies as required to substantiate any relevant case work or
reports.
Daily travel in the field.
BACKGROUND/EXPERIENCE desired:
Registered Nurse (RN) with active state license in good standing in
the state where job duties are performed.
Minimum 2 years clinical nursing background
Prior case management and workers' compensation experience
preferred
Ability to multitask in a fast paced work environment
Strong computer skills with experience in Microsoft Office
Products
Excellent communication skills
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Certified Case Manager (CCM) is desired
Nursing/Registered Nurse (RN) in CA is required
TELEWORK SPECIFICATIONS:
Full Time Telework (WAH) but with need for local travel out in the
field. The candidate needs to reside in the greater Sacramento, CA
area and cover up to the Chico/Yuba City areas as well as cover for
Redding, CA.
Field Case Mgr - Vocational - Part Time
Requisition # 35008BR
POSITION SUMMARY
Responsible for assessing and analyzing an injured employee to
evaluate the vocational needs required to facilitate the patients
appropriate and timely return to work. Acts as a liaison with
patient/family, employer, provider(s), insurance company, and
healthcare personnel.
FUNDAMENTAL COMPONENTS:
Assesses and analyzes an injured employees vocational status;
develops a plan of care to facilitate the patients appropriate and
timely return to work.
Interviews patients in their homes, work-sites, or physicians office
to provide ongoing case management services.
Conducts vocational testing, job site analysis, job development,
counseling and placement to manage patients return to work
status; monitors patient progress toward desired outcomes
through assessment and evaluation.
Communicates both in-person and telephonically with patient,
medical providers, attorneys, employers and insurance carriers;
prepares all required documentation of case work activities.
Arranges referrals, consultations and therapeutic services for
patients on a PRN basis; confers with specialists concerning course
of care and treatment.
Develops and administers educational and prevention programs.
Adheres to all laws and regulations that apply to the provision of
rehabilitation services; applies all special instructions required by
individual insurance carriers and referral sources.
Testifies as required to substantiate any relevant case work or
reports.
Performs other related duties as assigned.
BACKGROUND/EXPERIENCE desired:
-Certification with the WA State Workers Compensation Court
required
-Minimum of three years' case management experience required.
-National professional certification (CRC or CDMS required)
-Knowledge of laws and regulations governing delivery of
rehabilitation services.
-Knowledge of workers compensation and disability industry.
-Ability to travel locally as required
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
TELEWORK SPECIFICATIONS:
Telework Position (WAH) with daily travel in the field. Candidates
should reside in the Seattle, WA area.
Field Case Mgr-Medical
Requisition # 35838BR
POSITION SUMMARY
Assess and analyze an injured employee to evaluate the medical
and vocational needs required to facilitate the patient's
appropriate and timely return to work. Acts as a liaison with
patient/family, employer, provider(s), insurance companies, and
healthcare personnel.
FUNDAMENTAL COMPONENTS:
Assesses and analyzes an injured employee's medical and
vocational status; develops a plan of care to facilitate the patient's
appropriate and timely return to work. Interviews patient's in
their homes, work sites, or physician's office to provide ongoing
case management services. Monitors patient progress toward
desired outcomes through assessment and evaluation.
Communicates both in person and telephonically with patients,
medical providers, attorneys, employers and insurance carriers;
prepares all required documentation of case work activities. May
arrange referrals, consultations and therapeutic services for
patients; confers with specialists concerning course of care.
Applies all laws and regulations that apply to the provision of
rehabilitation services; applies all special instructions required by
individual insurance carriers and referral sources. Performs other
related duties as assigned.
BACKGROUND/EXPERIENCE desired:
Registered Nurse with active state license in good standing in AL is
required. Ability to work independently. Proficiency with MS
Word, Excel, Outlook, and PowerPoint. Ability to travel locally.
Knowledge of workers compensation. Field Case Management
experience preferred. National professional certification (CDMS,
CRRN, COHN, or CCM) preferred but not required.
EDUCATION
The highest level of education desired for candidates in this
position is a Associate's degree or equivalent experience.
TELEWORK SPECIFICATIONS:
Full-Time Telework (WAH).
Field Case Mgr-Medical CA
Requisition # 35009BR
POSITION SUMMARY
Responsible for assessing and analyzing an injured employee to
evaluate the medical and vocational needs required to facilitate
the patients appropriate and timely return to work. Acts as a
liaison with patient/family, employer, provider(s), insurance
companies, and healthcare personnel.
FUNDAMENTAL COMPONENTS:
Assesses and analyzes an injured employees medical and
vocational status; develops a plan of care to facilitate the patients
appropriate and timely return to work.
Interviews patients in their homes, work-sites, or physicians office
to provide ongoing case management services.
Monitors patient progress toward desired outcomes through
assessment and evaluation.
Communicates both in-person and telephonically with patient,
medical providers, attorneys, employers and insurance carriers;
prepares all required documentation of case work activities.
May arrange referrals, consultations and therapeutic services for
patients; confers with specialists concerning course of care and
treatment.
Develops and administers educational and prevention programs.
Applies all laws and regulations that apply to the provision of
rehabilitation services; applies all special instructions required by
individual insurance carriers and referral sources.
Testifies as required to substantiate any relevant case work or
reports.
Daily travel in the field.
BACKGROUND/EXPERIENCE desired:
Registered Nurse (RN) with active state license in good standing in
the state where job duties are performed.
Minimum 2 years clinical nursing background
Prior case management and workers' compensation experience
preferred
Ability to multitask in a fast paced work environment
Strong computer skills with experience in Microsoft Office
Products
Excellent communication skills
EDUCATION
The highest level of education desired for candidates in this
position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Certified Case Manager (CCM) is desired
Nursing/Registered Nurse (RN) is desired
TELEWORK SPECIFICATIONS:
Full time Telework (WAH) position with daily local travel in the
field visiting providers and injured workers. Candidates should
reside in San Diego.
Field Case Mgr-Medical- Tampa, FL
Requisition # 35365BR
POSITION SUMMARY
THIS LOCATION IS LOCAL TO THE TAMPA, FL AREA ONLY
MUST BE AN RN
MUST HAVE ONE OFTHESE NATIONAL CERTIFICATIONS: CCM,
COHN, CRRN, CDMS
PRIOR FIELD WORK EXPERIENCE PREFERRED
WORKERS COMPENSATION A PLUS
Field case management position in workers' comp industry and
managing a case load of injured workers. Position includes
coordination of services with client, adjuster, physicians, employer
etc to return to work and maximum medical improvement.
FUNDAMENTAL COMPONENTS:
The FCM is a work at home/field work position which provides
challenges in a fast paced environment. CM will balance visit with
the client (physicians, employer, PT, attorney etc) with
communication/coordination and paperwork. Requires 50-75%
car travel, and ability to work in a computer tech environment.
Communication skills, both verbal and written are critical, as is
multi tasking and time management skills. This position requires
critical thinking and the ability to work independently. The goal of
the position is to coordinate services and provide a pathway for
the client to return to work and reach maximum medical
improvement.
BACKGROUND/EXPERIENCE desired:
Position requires an RN with one of the following: CCM, CRRN,
CDMS, or COHN. Candidate must possess solid computer and tech
skills and the ability to communicate effectively. Desire to travel in
a fast paced position with multi-tasking and a positive QA
approach a must.
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Nursing/Certified Case Manager (CCM) is desired
Nursing/CRRN - Certified Rehabilitation Registered is desired
Nursing/Certified Disability Management Specialist (CDMS) is
desired
FUNCTIONAL EXPERIENCES
Nursing/Case Management/1-3 Years
Customer Service/Customer service - retail environment/1-3 Years
Information Technology/Computer operations/1-3 Years
TECHNOLOGY EXPERIENCES
Remote Access/WAH (Work at Home)/1-3 Years/End User
Desktop Tools/Microsoft Word/1-3 Years/End User
TELEWORK SPECIFICATIONS:
Full time WAH, with mobile travel. Closest Aetna office- Queen
Palm in Tampa, Florida.
Field Case Mgr-Medical-LaFayette, IN
Requisition # 35466BR
POSITION SUMMARY
Responsible for assessing and analyzing an Injured employee to
evaluate their needs; required to facilitate the patient's
appropriate and timely return to work.
Patient/Family, employer, provider (s),insurance companies and
healthcare liaison.
FUNDAMENTAL COMPONENTS:
No holiday or weekends. Work independently as a consultant with
additional monthly bonus incentives.
BACKGROUND/EXPERIENCE desired:
Must have IN RN license, Strong med-surg clinical background,
minimum of 10yrs of RN experience. Preferred CCM & Spanish
Bilingual; Prior Workers Comp/Case Management/ Rehab
experience a plus.
EDUCATION
The highest level of education desired for candidates in this
position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
RN license is required
Medical Management/ is required
Healthcare Management/ is desired
FUNCTIONAL EXPERIENCES
Nursing/Medical-Surgical Care/7-10 Years
Nursing/Case Management/1-3 Years
Nursing/Disability/1-3 Years
Nursing/Occupational/1-3 Years
Information Technology/Computer operations/1-3 Years
TELEWORK SPECIFICATIONS:
FTE-32 hrs per week
Field Case Mgr-Medical-Lexington, KY
Requisition # 35775BR
POSITION SUMMARY
THIS POSITION IS LOCAL TO RICHMOND, SOMERSET, PIKEVILLE,
CORBIN, KY. AREA.
PART TIME 25 HOURS PER WEEK.
DAILY TRAVEL REQUIRED FROM HOME OFFICE
Position to provide field case management services in the
Richmond, Somerset, Pikeville, Corbin KY areas for injured
workers, with goal of timely return to work. Includes meeting one
on one with injured workers, employers, physicians, and other
providers. Must have excellent verbal and written communication
skills; be well organized.
FUNDAMENTAL COMPONENTS:
Must be licensed KY RN in good standing with unrestricted drivers
license and reliable means of transportation. Responsible for
assessing and analyzing an injured worker to evaluate the medical
and vocational needs required to facilitate appropriate and timely
return to work. Acts as a liaison with injured worker/family,
employer, provider(s), insurance company and attorney.
Interviews injured worker in their home, work-sites or physician
office to provide ongoing case management services.
Communicates both in person and telephonically with all parties.
Prepares all documentation of case work activities in a timely
manner. Must be flexible and able to multi-task.
BACKGROUND/EXPERIENCE desired:
Current unrestricted KY RN license. CCM preferred. Workers
compensation knowledge a bonus. Experienced and very
comfortable working with WORD documents, EXCEL and Outlook.
Home health care experience a definite plus.
EDUCATION
The highest level of education desired for candidates in this
position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Nursing/Certified Case Manager (CCM) is desired
FUNCTIONAL EXPERIENCES
Functional - Nursing/Medical-Surgical Care/1-3 Years
TECHNOLOGY EXPERIENCE
Microsoft Word/1-3 Years
TELEWORK SPECIFICATIONS:
Telework is a requirement for this position (no physical office
location). Classification is Mobile-daily travel required. Travel area
includes Richmond, Somerset, London, Corbin, Pikeville KY areas
and a 90 mile radius from home base.
Health Coach - Wellness
Requisition # 35494BR
Info Sr Security Engr
Requisition # 35553BR
POSITION SUMMARY
The Senior Engineer for the Security Operation team will serve as
a Level 3 incident responder and overall program manager for
specific functions including health of technology, process
improvements or new system implementation and tuning. Senior
Engineers are expected to help mentor less experienced staff and
support leadership in fulfillment of the organization's mission and
objectives.
FUNDAMENTAL COMPONENTS:
The Senior Engineer is a critical member of the Security
Operations & Incident Response team responsible for advanced
and deep network analysis, intrusion detection identification,
incident triage, project management, and fulfillment of
remediation activities. The Senior Engineer will serve as a team
contact for escalations during after hours on-call incidents and
alerts. The successful candidate will have experience in the review
and analysis of intrusion detection systems, security incident
event management systems, network traffic and data from
solutions such as anti-malware, advanced endpoint
detection/prevention, firewalls, internet/email gateways and
VPNs. Experience in packet analysis to identify anomalies in
protocols and payloads as well as a security penchant to stay
current with the latest malcode, attack vectors and security trends
is also required. The Senior Engineer will be responsible for
incident handling, discovery, triage, containment, recovery, and
remediation plan coordination when needed. He/She will assist
with evaluation and integration of new products and technologies
and provide project support related tasks to integrate security
platforms as well as ongoing tuning support for existing
technology. Ultimately, Senior Engineers in the team serve as
mentors leveraging their compendium of knowledge and skill sets
to help elevate the overall skill set of the team and help bake-in
continuous improvement strategies.
BACKGROUND/EXPERIENCE desired:
Expert level understanding of network security devices, protocols,
routing, and services. Experience with analysis of adverse server,
network, web and mail security events. Experience engineering
SIEM solutions including tuning and orchestration. Excellent
written and verbal communication skills required. Security
certifications such as Security+, CISSP, GSEC, GPEN, etc. are a plus.
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Information Management/Certified Information Systems Security
Professional (CISSP) - - sponsored by International Information
Systems Security Certification Consortium is desired
Information Technology/GIAC Incident Handler (GCIH) - Global
Information Assurance Certification is desired
FUNCTIONAL EXPERIENCES
Functional - Information Technology/Security/4-6 Years
Functional - Information Technology/Data / info management &
architecture/4-6 Years
TECHNOLOGY EXPERIENCES
Technical - Security/Intrusion Detection/4-6 Years/Power User
Technical - Network/IP/4-6 Years/System Support
Technical - Security/Norton Antivirus/4-6 Years/Administrator
REQUIRED SKILLS
Technology/Leveraging Technology/MASTERY
DESIRED SKILLS
Technology/Promoting Emerging Technology/MASTERY
TELEWORK SPECIFICATIONS:
Flexible work-at-home and/or office based schedule available as
discussed between the candidate and the hiring team.
Informatics Analyst
Requisition # 35205BR
Information Security Lead
Requisition # 32605BR
POSITION SUMMARY
Join a dedicated information security team tasked with creating a
mature risk based diverse information security programs in
today's challenging healthcare security landscape. We are looking
for a motivated experienced professional with broad expertise in
managing security risk, experience implementing security
initiatives and incident response management.
FUNDAMENTAL COMPONENTS:
Manages projects including scope definition, prioritization and
resource management. Requires an advanced understanding of
security policies, methods and tools in order to provide informed
leadership to both the security team as well as the organization as
a whole. This role is responsible for implementing a Risk based,
security framework, as well as leading controls monitoring and
some audit support.
The position is responsible for developing, implementing and
reviewing information security strategies. Consults with business
leaders to assess risk based upon security issues, best practices
and business needs. Works closely with all levels of the
organization to review plans and projects to ensure adherence to
security standards. Leads incident response, breach response and
some compliance related activities. This role will focus on
vulnerability remediation in infrastructure and software. Interacts
regularly with additional security teams in Aetna to create a risk
based security culture across multiple environments.
BACKGROUND/EXPERIENCE desired:
* Minimum Bachelors, security certification (ISC2, ISACA, GIAC
certification)
* High level of expertise in security control design and oversight
for endpoints, servers, networks, software
* Knowledge of Quantitative Risk Analysis
* Ability to function at a high level in a fast paced, dynamic
environment with competing priorities and multiple demands
under tight deadlines
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Information Technology/Certified in Risk and Information Systems
Control certification (CRISC) is desired
Information Technology/Certified in the Governance of Enterprise
Information Technology (CGEIT) is desired
Information Technology/GIAC Security Engineer (GSE) - Global
Information Assurance Certification is desired
Information Technology/Information Technology Infrastructure
Library (ITIL) is desired
FUNCTIONAL EXPERIENCES
Functional - Information Technology/Security/4-6 Years
Functional - Information Technology/Application architecture/4-6
Years
Functional - Information Technology/Program management/1-3
Years
REQUIRED SKILLS
Leadership/Anticipating and Innovating/MASTERY
Leadership/Collaborating for Results/MASTERY
Technology/Creating Technology Partnerships/MASTERY
DESIRED SKILLS
Technology/Selecting and Applying Technology
Solutions/MASTERY
Technology/Leveraging Technology/MASTERY
Leadership/Developing and Executing Strategy/ADVANCED
TELEWORK SPECIFICATIONS:
Telework is a requirement for this position (no physical office
location). However, this position will require 25%-50% travel to
New York City offices.
Training period in the office may be required
Joint Venture Sales Leader
Requisition # 35770BR
POSITION SUMMARY
The Aetna/Innovation Health leadership team is looking for a Sr.
Director, Middle Market Sales and Service to be located in our
Falls Church, Virginia office. ***Please note this is not a telework
position**
The position will be responsible for sales, account management
and business retention for Aetna/Innovation Health products and
services in support of profitable growth and other business
objectives. Manage sales and retention efforts for assigned joint
venture business and associated customer segments, products
and geographies
FUNDAMENTAL COMPONENTS:
Establishes specific goals for assigned areas of responsibility in line
with strategic objectives in conjunction with Joint Venture (JV)
business.
Builds successful relationships with constituents (producers, plans
sponsors, customers, providers).
Thought leader that deepens the awareness of the value
proposition of a Joint Venture that is successfully completed
through solid relationships (internal and external) and other
established channels
Develops executive-level material and presents progress status to
Senior leadership
Subject matter expert for alternative distribution channels,
maintaining awareness of industry, company, competitor,
legislative and regulatory activities through analysis of the
competitive environment and market forces and provides insights
to the organization to help improve distribution position.
Provides input to provider and network development areas to
ensure competitive products and services.
Develops, executes and communicates a comprehensive strategy
aligned with customer’s objectives, financial position and
employee benefits strategies.
Works effectively cross-functionally internally to complete sales,
installation, servicing and product development activities as
appropriate.
Oversees communication and planning among key stakeholders
that ultimately results in the delivery of a successful finalist
presentation.
Leads a team of sales/account management professionals
Responsible for recruiting, training and developing staff.
Monitors industry information and competitive environment of
the marketplace to position Aetna’s strength accordingly.
Educates constituents on Aetna specific policies, product
information, and procedures as well as industry issues and related
current topics and expects the same of team members (e.g.,
HIPAA, health disparities).
Manages complex negotiations. Positions products, rate levels and
expanded product portfolios to increase sales and maximize
revenue.
Exhibits behaviors outlined in the Employee Behaviors.
BACKGROUND/EXPERIENCE desired:
At least 10 years of industry sales experience.
At least 5 years of sales management experience.
Extensive experience in the Northern VA and Virginia-wide
markets
EDUCATION
Bachelor's degree or equivalent experience.
Legislation and Filing Implementation Manager
Requisition # 35872BR
Marketing Director
Requisition # 35941BR
MI MCD Credentialing Analyst
Requisition # 34781BR
POSITION SUMMARY
Review, analyzes, evaluates, validates provider/producer
information against business/credentialing requirements and
maintains information in credentialing data bases. Support
extensive research and analysis of sensitive provider/producer
issues; addresses data integrity issues.
Fundamental Components:
Participates in development of credentialing processes and
workflows. Provides issue resolution for providers/producers,
during the credentialing or data management processes.
Responds to network or provider/producer inquiries including
contracting and credentialing status.
BACKGROUND/EXPERIENCE desired:







Track record of prioritizing work, multi-tasking, and
managing workload efficiently.
Possesses a working knowledge of Business
Review/Credentialing processes
EPDB, EPC and CARDS: Preference
Ability to consistently meet and/or exceed
performance/production goals.
1-2 years of business review and credentialing; Strong
preference
2 years Data Shifting and Analyst; Strong Preference
1-2 Customer Service; Preference
EDUCATION
The minimum level of education desired for candidates in this
position is a High School diploma, G.E.D. or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Network Management/Credentialing/1-3 Years
Functional - Network Management/Provider relations/1-3 Years
Functional - Network Management/Provider data services/1-3
Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Aetna Applications/QNXT/1-3 Years/End User
Technical - Aetna Applications/EPDB Canned Reports/1-3
Years/End User
REQUIRED SKILLS
General Business/Applying Reasoned Judgment/ADVANCED
Leadership/Creating Accountability/FOUNDATION
General Business/Communicating for Impact/ADVANCED
Middle Market Account Associate
Requisition # 35259BR
There will be local travel and candidates should be comfortable
commuting around Pittsburgh, PA.
POSITION SUMMARY
In the Middle Market Account Associate position you will support
account servicing for assigned constituents (producers, plan
sponsors, customers), business or customer segment, products
and services and geographies.
Fundamental Components includes, but is not limited to:
Identifies constituent-specific service issues, identifies solutions
and may lead resolution of issues working with other areas.
Provides constituents with Aetna policy, plan design and benefit
changes and network updates including analysis of impact.
Collaborates with account management team to achieve
growth/renewal objectives; may assist in preparation and delivery
of renewal packages.
May support plan administration activities, including installation,
open-enrollment, plan set-up, eligibility, billing and drafting by
working proactively with support areas; signs-off on ID cards.
May assist in constituent training on product and policy questions.
May take initial calls for direct sales requests and forward
requests to appropriate sales staff.
BACKGROUND/EXPERIENCE desired:
2-5 plus years of health insurance industry experience; Preference
Knowledge of sales support and underwriting functions;
Preference
2-5 plus years Customer Service, Client management, or Account
Management; Required
Microsoft Office Suite Proficiency; Required
EDUCATION
The minimum level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Insurance/License, Life/Health (PA) is desired
FUNCTIONAL EXPERIENCES
Functional - Customer Service//1-3 Years
Functional - Products-Medical//1-3 Years
Functional - Products-Dental//1-3 Years
Functional - Claims//1-3 Years
DESIRED SKILLS
Service/Case Administration/FOUNDATION
Service/Providing Solutions to Constituent Needs/FOUNDATION
Service/Demonstrating Service Discipline/FOUNDATION
NAT Sr Sales Executive
Requisition # 35048BR
POSITION SUMMARY
Motivates and sells solution-based health and wellness products
and services to consultants and customers with 3,000 employees
or greater and headquartered in TX or OK.
FUNDAMENTAL COMPONENTS:
Cultivates strong, productive and influential relationships with
brokers/consultants, customers, and peers
Implements strategies necessary to attain sales objectives in
assigned areas.
Manages complex negotiations. Positions products, rate levels,
and expanded product portfolios to increase sales and maximize
revenue.
Manages the integration of clients and Aetnas internal
organizations to meet clients installation needs and close the deal.
Identifies various ways to partner with the client by drawing from
entire spectrum of product line. Gains understanding of clients
multifaceted needs and recommends appropriate benefits of
Aetnas full product array (e.g., fully vs. self-insured, combination
of products and/or covers a range of industries).
Provides effective presentations to Aetna constituents.
BACKGROUND/EXPERIENCE desired:
8+ years of industry experience.
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Insurance/Life and Health Insurance License is desired
FUNCTIONAL EXPERIENCES
Functional - Sales & Service/Complex negotiations/7-10 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft PowerPoint/7-10
Years/Power User
Technical - Desktop Tools/Microsoft Word/7-10 Years/Power User
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/Power
User
REQUIRED SKILLS
General Business/Managing Sales Relationships/ADVANCED
Sales/Cultivating Distribution Channels/ADVANCED
Sales/Negotiating Collaboratively/MASTERY
DESIRED SKILLS
Leadership/Developing and Executing Strategy/ADVANCED
Sales/Knowing Markets/ADVANCED
Sales/Selling Products and Services/ADVANCED
TELEWORK SPECIFICATIONS:
This is a flexible telework position and may require several days a
week in the office; the position can be located in Texas or
Oklahoma.
Network Account Manager
Requisition # 35957BR
POSITION SUMMARY
Design, develop, contract, maintain and enhance relationships
with facilities, physicians and ancillary providers which serve as
contractual networks of care for members; foster growth of
managed care products; and enhance profitability of Aetna.
Develops strong relationships with network providers and internal
business partners leading to the achievement of provider
satisfaction, medical cost targets, network growth and/or
efficiency targets.
Note: WORK AT HOME considered only for Minneapolis/St. Paul
residents
FUNDAMENTAL COMPONENTS:
Executes strategic components of the HCD business plan for each
market
Coordinates with segment constituents on medical cost and
membership growth and network fortification initiatives.
Communicates with external constituents to effectively engage
the provider community and demonstrate the Aetna
value proposition.
Negotiate contracts and other understandings on behalf of the
company.
Manages medical cost drivers and executes specific medical cost
initiatives to support financial and medical cost
objectives.
Proactively identifies new trends and products within Aetna and
the industry and works to raise awareness throughout the
organization in order to gain consensus on a course of action and
ultimately drive to implementation.
Consistently monitors Aetna service capabilities to collaboratively
ensure that provider constituents needs are met.
Seeks to optimize provider interaction and provides
recommendations based on balance of provider needs and
Aetna's objectives.
Responsible for developing and maintaining relationships with
physician and business leadership of key physician
groups, ancillary providers, and delivery systems.
Interacts with large, high profile physician groups, IPAs, PHOs and
hospital systems to facilitate solutions that are
mutually beneficial for both providers and the organization.
Collaborates cross-functionally on more complex issues to ensure
provider needs are met and outstanding issues are resolved,. i.e.
provider service efficiencies, provider service improvement
initiatives, identifies opportunities for process improvement.
Collaborates with internal team members on the implementation
of large, high profile physician groups, IPAs, PHOs
and hospital systems to ensure a positive business relationship.
Exhibits the following Network Account Manager Behaviors
BACKGROUND/EXPERIENCE desired:
Proven ability to synthesize and translate competitive intelligence
into decision-making process.
Multi-functional experience
2-5 years industry experience. (Medical Cost Drivers and Managed
Care Industry
Working knowledge of provider business operations (PRL)
Analytical/data driven decision-making skills
Strong analytical and written/oral communication skills.
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
Network Manager
Requisition # 35955BR
POSITION SUMMARY
Negotiates, competitive and complex contractual relationships
with providers according to pre-determined internal guidelines
and financial standards. Works cross-functionally to execute
network strategies. Maintains accountability for specific medical
cost initiatives.
Note: WORK AT HOME considered only for Minneapolis/St. Paul
residents
FUNDAMENTAL COMPONENTS:
Effectively negotiates complex, competitive contractual
relationships with providers according to prescribed guidelines in
support of national and regional network strategies
Manages provider compensation/reimbursement and pricing
development activities
Responsible for understanding and managing medical cost issues
and initiating appropriate action
Provides sales and marketing support, community relations and
guidance with comprehension of applicable federal and state
regulations
Assist and facilitate business intent reviews (BIR)
Initiate legal reviews as needed; ensure all required reviews
completed by appropriate functional areas.
Regional owner of Strategic Contact Manager (SCM) and rate
wizard
BACKGROUND/EXPERIENCE desired:
Must possess a successful track record negotiating large hospital
system contracts.
Comprehensive understanding of hospital and physician financial
issues and how to leverage technology to achieve quality and cost
improvements for both payers and providers.
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree, MBA/Master's degree preferred.
Part D Adhoc Senior Consultant
Requisition # 35719BR
We are hiring a Part D Adhoc Senior Consultant! In this role you
will provide consultation on the design, testing and enhancement
of information product including technical assistance and product
development support to external and internal customers.
Researches, manipulates and prepares complex data to document
program activities and reports on its results.
This position is open to work from home full time and is not
location specific. Willing to consider candidates based on location.
Aetna offers excellent benefits, 401k, bonus potential and much
more!
FUNDAMENTAL COMPONENTS:
(*) May lead or act as a business technical expert with the
planning, development and validation of master or detail test
plans and strategies.
(*) Performs ongoing research, and support tasks for existing
systems.
(*) Analyzes complex data for trends, highlights in-depth
interpretations and provides in-depth root cause analysis.
(*) Provides workgroup support on projects.
BACKGROUND/EXPERIENCE desired:
(*) 3-5 years of data interpretation and analysis experience.
(*) Extensive experience with databases as well interpretation and
manipulation of related data.
(*) Healthcare background.
(*) Excellent verbal and written communication skills.
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - General Management/Data analysis &
interpretation/4-6 Years
Functional - General Management/Process & quality
improvement/4-6 Years
Functional - Information Management/Business information
analysis/4-6 Years
Functional - Information Management/Supports the maintenance
of scoreable action items documents by providing ad hoc
analysis/4-6 Years
Functional - Information Management/Query and Database
Access Tools/4-6 Years
TECHNOLOGY EXPERIENCES
Technical - Database/UNIX/AIX/4-6 Years/End User
Technical - Reporting Tools/SAS/4-6 Years/End User
Technical - Database/Microsoft Access/4-6 Years/End User
Technical - Aetna Applications/Aetna Pharmacy Management
Claim Adjudication Sys/1-3 Years/End User
REQUIRED SKILLS
General Business/Turning Data into Information/MASTERY
Leadership/Driving Change/ADVANCED
General Business/Communicating for Impact/MASTERY
DESIRED SKILLS
General Business/Applying Reasoned Judgment/ADVANCED
Service/Demonstrating Service Discipline/ADVANCED
TELEWORK SPECIFICATIONS:
Full-Time Telework (WAH)
Considered for any US location; training period in the office may
be required
Pharmacist
Requisition # 35374BR
Pharmacist Supervisor-Pharmacy
Requisition # 35983BR
Pharmacy Service Manager
Requisition # 34036BR
POSITION SUMMARY
The Pharmacy Service Manager will be responsible for
development, implementation and management of specialty
pharmacy clinical UM criteria and specialty drug class strategy for
Aetna Pharmacy Management. This strategy includes pipeline
management, P&T Drug Monograph and drug/disease
whitepaper, specialty medical and pharmacy drug list
development and maintenance. Strong clinical and analytical skills
required.
Highly Preferred that Candidate will have previous experience
with a Health Insurance Company or Pharmacy Benefits
Company.
FUNDAMENTAL COMPONENTS:
The Pharmacy Service Manager will coordinate across Product
Strategy and APM partners to develop and implement a broad
specialty pharmacy clinical UM drug management strategy.
BACKGROUND/EXPERIENCE desired:
Licensed Health Care Professional (Registered Nurse or
Pharmacist) with current registration to practice.
In-depth knowledge and experience in Specialty
Formulary/Clinical UM criteria design, development and
management within managed care / managed pharmacy /
competitive environment.
Minimum of 5 years clinical pharmacy/administrative experience
or equivalent
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is desired
Pharmacy/Registered Pharmacist (RPh) is desired
Pharmacy/Registered Pharmacist is desired
FUNCTIONAL EXPERIENCES
Functional - Clinical / Medical/Direct patient care (hospital, private
practice)/4-6 Years
Functional - Medical Management/Medical Management - Clinical
coverage and policies/4-6 Years
Functional - Nursing/Clinical coverage and policies/4-6 Years
Functional - Medical Management/Medical Management Pharmacy/4-6 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/Power
User
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/Power
User
Technical - Hardware/Printers/1-3 Years/Power User
REQUIRED SKILLS
Benefits Management/Interacting with Medical
Professionals/ADVANCED
Leadership/Driving Strategic and Organizational
Agility/ADVANCED
Service/Working Across Boundaries/ADVANCED
DESIRED SKILLS
Leadership/Developing and Executing Strategy/ADVANCED
Technology/Leveraging Technology/ADVANCED
TELEWORK SPECIFICATIONS:
Full-Time Telework (WAH)
PLS Account Executive
Requisition # 35521BR
Provider Relation Liaison
Requisition # 35537BR
POSITION SUMMARY
The Provider Relations Liaison (PRL) position is responsible for
providing education, technical assistance, follow up, and support
to the Mercy Maricopa contracted Provider Network.
FUNDAMENTAL COMPONENTS:
-PRL is responsible for education, technical assistance, and
support to the Mercy Maricopa contracted provider network.
-PRL schedules weekly, monthly, or quarterly visits with
contracted providers to confirm compliance with contract
requirements, contract deliverables, and State / Regulator
requirements.
-PRL tracks all interactions with contracted providers by phone, email, face-to-face meetings, and on-site visits.
-PRL provides excellent customer service skills, returning calls
within one working day, responding to e-mails daily, providing a
response to open issues within 3 working days, and coordinates
responses from other departments necessary to resolve provider
issues.
-PRL shall attend internal and external providers’ meetings
necessary to provide support to the contracted provider network.
-PRL writes responses to provider inquiries, creates agendas for
provider meetings, speaks and presents provider information at
monthly internal and external meetings, and writes and delivers
responses to State inquiries
BACKGROUND/EXPERIENCE desired:
- Three (3+) Years Provider Relations experience in Managed Care
/ Behavioral Health .
- Knowledge of the AHCCCS system / Behavioral Health preferred.
- Ability to manage multiple priorities.
- Excellent customer service skills
- Advance knowledge of computer systems, Word, Excel, Power
Point, Outlook, data entry and tracking
- Ability to Speak and Train in Group Settings
EDUCATION
The highest level of education desired for candidates in this
position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Customer Service/ is desired
Managed Care/ is desired
Claims/ is desired
Healthcare Management/ is desired
FUNCTIONAL EXPERIENCES
Functional - Customer Service/FE Customer Service - Provider HMO/1-3 Years
Functional - Claims/Claim processing - Medical - Behavioral
Health/1-3 Years
Functional - Network Management/Provider relations/4-6 Years
Functional - Project Management/Project Leader/1-3 Years
TECHNOLOGY EXPERIENCES
Technical - Database//1-3 Years/System Support
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/System
Support
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/System
Support
Technical - Desktop Tools/Microsoft Word/1-3 Years/System
Support
RN-Field Case Mgr-RN-Charleston,Clarksburg, Morgantown, WV
Requisition # 32874BR
Senior Director of Compliance
Requisition # 35567BR
POSITION SUMMARY
The Senior Compliance Director, Medicare Compliance has
responsibility for oversight of all Medicare Compliance activities
relating to Special Project. The Senior Compliance Director must
ensure that the requirements of an effective Medicare
Compliance program are met by Aetna as a FDR and that Aetna is
providing the resources to achieve these requirements. The Senior
Compliance Director will work closely with all staff in Medicare
Compliance to ensure that the elements of such a program as
described in CMS Chapters 9 &21, Compliance Program
Effectiveness, are achieved and maintained.
FUNDAMENTAL COMPONENTS:
Key attributes include the distribution and validation of regulatory
alerts, oversight of auditing and monitoring, evaluating risk and
ensuring documentation to demonstrate an effective Medicare
Compliance program. The Senior Compliance Director will work
closely to address and resolve issues pertaining to Medicare
Compliance, regulatory interpretation and the execution of an
effective Medicare Compliance program. This position promotes
compliance with CMS regulations and related-company policies,
including the Aetnas Code of Conduct.
RESPONSIBILITIES INCLUDE:
Implements, leads and maintains an effective Medicare
Compliance program for Project Derby and each buyer
Is a leader for Medicare subject matter experts, especially in
Medicare compliance to support the requirements of an effective
Medicare Compliance program for Project Derby
Monitors CMS regulations and provides direction to ensure
Aetnas administrative and operational activities comply with
regulations for Project Derby
Maintains current working knowledge and expertise in Medicare
Compliance with a strong focus on Medicare Compliance Program
Effectiveness
Conducts activities, including monitoring and auditing as outlined
in Medicare Compliance Work Plan and needed by Project Derby
to evaluate compliance; proposes corrective action where
necessary and monitors implementation of such corrective action
EXHIBITS THE FOLLOWING BEHAVIORS:
Anticipate and respond to future risk situations
Strong Acumen of Medicare Compliance and FDR requirements
Apply knowledge to address issues
Serve as an Aetna spokesperson
Demonstrate critical thinking
Drive and execute strategy
Creating ownership
Promote collaboration among stakeholders
Institutionalize compliance as a core competency
BACKGROUND/EXPERIENCE desired:
Minimum 3-5 years in Regulatory/Compliance Mgmt in Medicare
Compliance, experience working on Medicare Compliance
program effectiveness (CPE). Strong leadership skills in working
cross functionally and in project management in a large corporate
environment. BA or BS degree in Healthcare and/or related field
required. Masters or higher degree in Law, Business, Health Care
or other applicable area
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Legal/Compliance/4-6 Years
Functional - Legal/Compliance - investigation/4-6 Years
Functional - Legal/Compliance - training/education/4-6 Years
Functional - Management/Management - Project management
(non-IT)/4-6 Years
Functional_Experience/Functional_Focus/4-6 Years
REQUIRED SKILLS
General Business/Communicating for Impact/MASTERY
General Business/Demonstrating Business and Industry
Acumen/MASTERY
Leadership/Collaborating for Results/MASTERY
DESIRED SKILLS
Leadership/Creating Accountability/MASTERY
Leadership/Driving a Culture of Compliance/MASTERY
Service/Providing Solutions to Constituent Needs/ADVANCED
TELEWORK SPECIFICATIONS:
Full-Time Telework
Senior Network Manager - Value Based Agreements
Requisition # 35066BR
Senior Sales Executive
Requisition # 36017BR
Senior Sales Executive – Group Retiree Medicare Benefits
Requisition # 33179BR
Social Worker
Requisition # 33842BR
POSITION SUMMARY
With a focus on delivering comprehensive, patient-centered care
across the health care continuum, the Social Worker will work
closely with the Case Manager and physician practices to support
the patient care plan on patients with complex health care needs.
Utilizing advanced clinical judgment and critical thinking skills the
Social Worker facilitates appropriate physical and behavioral
healthcare and social services for patients through assessment
and member-centered care planning, direct provider
coordination/collaboration, and coordination of psychosocial
wraparound services to promote effective utilization of available
resources, optimal member functioning, and cost-effective
outcomes.
The area of coverage would support VA and DC
FUNDAMENTAL COMPONENTS:
Assessment of Members through the use of clinical tools and
review of member specific health information/data
Conducts comprehensive assessments of referred members
needs/eligibility and, in collaboration with the members care
team, determines an approach to resolving member issues and/or
meeting needs by evaluating the members benefit plan and
available internal and external programs/services and resources.
Applies clinical judgment to the incorporation of strategies
designed to reduce risk factors and barriers and address complex
clinical indicators which impact care planning and resolution of
member issues.
Using advanced clinical skills, performs crisis intervention with
members experiencing behavioral health or medical crisis and
refers them to the appropriate clinical and service providers for
thorough assessment and treatment, as clinically indicated.
Provides crisis follow up to members to help ensure they are
receiving the appropriate treatment/
services.
Using a holistic approach consults with clinical colleagues,
supervisors, Medical Directors and/or other programs to
overcome barriers to meeting goals and objectives. Presents cases
at case rounds/conferences to obtain a multidisciplinary
perspective and recommendations in order to achieve optimal
outcomes.
Identifies and escalates quality of care issues through established
channels
Ability to speak to medical and behavioral health professionals to
influence appropriate member care.
Utilizes influencing/motivational interviewing skills to ensure
maximum member engagement and promotes lifestyle/behavior
changes to achieve optimum level of health.
Provides coaching, information and support to empower the
member to make ongoing independent medical and/or healthy
lifestyle choices.
Helps member actively and knowledgably participate with their
provider in healthcare decision-making
Analyzes all utilization, self-report and clinical data available to
consolidate information and begin to identify comprehensive
member needs.
Utilizes negotiation skills to secure appropriate options and
services necessary to meet the member’s benefits and/or
healthcare needs.
BACKGROUND/EXPERIENCE desired:
3-5 years clinical practice experience, e.g., hospital setting,
alternative care setting such as home health or ambulatory care
required
Behavioral Health experience required
Case management and discharge planning experience preferred
Managed Care experience preferred
Crisis intervention skills preferred
Local travel required
EDUCATION
The highest level of education desired for candidates in this
position is a Master's degree.
LICENSES AND CERTIFICATIONS
Mental Health/Licensed Social Worker (LSW) is desired
Travel is required -- The area of coverage would support VA and
DC
The office is based in the Falls Church, VA area
Requisition # 35371BR
Requisition # 35373BR
Sr Account Manager - Work at Home
Requisition # 35700BR
POSITIONSUMMARY
Develops service strategy to ensure renewal and growth of
business and retention of existing membership for assigned book
of business.
Develops and manages service plans in the most proactive and
strategic manner possible, and finds new and innovate ways to
show customers the value of the products and services they have
purchased
FUNDAMENTAL COMPONENTS:
Achieve individual cross sell, growth/retention targets and client
satisfaction levels
Create collaborative partnerships with sales to develop a
comprehensive growth strategy for assigned book of business that
it is aligned with client's objectives
BACKGROUND/EXPERIENCE desired:
7-10 Years Account Management Experience
Carrier/TPA or Managed Care related Experience
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
TELEWORK SPECIFICATIONS:
Full-Time Telework (WAH)
Sr Coding Quality Auditor
Requisition # 34912BR
POSITION SUMMARY
Responsible for performing audits of medical records to ensure
the ICD-9/ICD-10 codes that are submitted to the Centers for
Medicare and Medicaid Services (CMS) for the Risk Adjustment
Payment System (RAPS) are appropriate, accurate, and supported
by written clinical documentation in accordance with all state and
federal regulations and internal policies and procedures.
Responsible for auditing quality coding auditors and providing
coding education and improvement plans. This role may require
coding and documentation education to providers.
FUNDAMENTAL COMPONENTS:
Responsible for conducting provider ICD-9/ICD-10 coding audits.
Responsible for retrieving medical records and validating HCC
submissions for internal data validation and CMS National and
Target audits. Responsible for ICD-9/ICD-10 coding for Provider
Education Program. Creating and presenting provider education to
providers in an effort to enhance medical documentation and
coding.
BACKGROUND/EXPERIENCE desired:
Minimum of 4 years recent and related experience in medical
record documentation review, diagnosis coding, and/or auditing.
CPC (Certified Professional Coder) or CCS-P (Certified Coding
Specialist-Physician) required
Experience with ICD9/ICD10 required.
Experience with Medicare and/or Medicaid Risk Adjustment
process required
Experience with Microsoft Office products (Word, Excel)
EDUCATION
The highest level of education desired for candidates in this
position is a Associate's degree or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Clinical / Medical/Clinical claim review & coding/4-6
Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/
Technical - Desktop Tools/Microsoft PowerPoint/4-6 Years/
Technical - Desktop Tools/Microsoft Word/4-6 Years/
TELEWORK SPECIFICATIONS:
Full-Time Telework (WAH).Considered for any US location;
training period in the office may be required
Sr Joint Venture Relationship Manager
Requisition # 35771BR
POSITION SUMMARY
Overall accountability for the satisfaction and success of clients,
including strategic alignment, reference ability, deliverables and
financial and operational success, as measured by both the client
and by Aetna. This includes establishing, influencing and/or
managing internal cross-functional groups such as
implementation, support, operations, and account management,
as well as the external client relationships to ensure effective
execution and ongoing operations. This person leads all aspects of
the engagement/client relationship with a team of highly matrixed
resources and works with the client’s executive leadership to
ensure financial, product, technology, clinical, and operational
goals are achieved. This person is responsible for developing and
executing an annual strategic business plan with each client to
exceed financial and other appropriate targets and grow the
business. Responsible for growing the business through new
technology, product offerings, or covered populations.
FUNDAMENTAL COMPONENTS & PHYSICAL REQUIREMENTS
include but are not limited to
Develops a mutually beneficial working relationship with various
clients by consulting on the operational design and
implementation of the business strategy while promoting the
objectives of improving health care outcomes and increasing
patient quality and value.
Sets the strategic vision and tone for the relationship and carries
out the operational plan to execute that strategy.
Seeks to optimize client interaction, anticipating client needs and
acting as the voice of the client internally, providing
recommendations based on client needs.
Defines, organizes, influences and/or leads a team of various
internal, client, and external resources to implement complex new
arrangements with combinations of financial, product,
technology, clinical, and operational elements such that the client
and the business meet all program goals.
Collaborates cross-functionally to monitor performance and
customer service efficiencies, including performance guarantees,
client and company clinical as well as financial goals.
Looks for ways to enhance the solution within the assigned client
organization to include identifying new functionality, programs,
products, services and technology to ensure better outcomes and
achievement of program objectives.
Has ultimate accountability for the project/engagement
management services being delivered including the organizations
budget and/or financial implications.
BACKGROUND/EXPERIENCE Desired
15+ years of hospital system and/or health insurance industry
experience.
15+ years of client management, healthcare industry preferred.
8+ years demonstrated knowledge of healthcare industry and
particularly ACOs.
Strong strategic consulting experience with either a provider or
payer.
Proven ability to interact with, influence and collaborate with
clients at all levels.
Proven experience managing matrixed staff with ability to
leverage non direct reports to complete tasks.
Proven track record managing complex projects and/or programs
that resulted in cost savings and high customer satisfaction.
Strong interpersonal skills
EDUCATION AND CERTIFICATION REQUIREMENTS
Bachelor's degree required. MBA or Master’s degree preferred.
Sr SAS Programmer/ Informatics Consultant/Lead-WAH
Requisition # 34870BR
State Filing Consultant - SERFF
Requisition # 35756BR
*Position location can be Hartford, CT or telecommute from any
location.
POSITION SUMMARY
The State Filing Consultant will be responsible for the preparation
of regulatory filing submissions and negotiations, and compliance
activities as they relate to Aetna products and program. The
consultant will determine if business and/or operational changes
have regulatory impact, prepare materials as necessary to comply
with regulatory requirements and negotiate and monitor the
approval process.
FUNDAMENTAL COMPONENTS:
Responsibilities include: - Analyze insurance laws and regulations,
determine applicability to Aetna products and programs, draft
language that meets regulatory requirements, and prepare and
negotiate filing approvals. - Promote Compliance as a Core
Competency while enforcing compliance with state/federal laws
and regulations, risk management policies and company policies
affecting Aetna business. - Monitor industry and regulatory trends
to identify potential risk factors and the need for change. Manage multiple priorities under tight deadlines to advance
speed-to-market expectations. - Adhere to standard work flow
processes on work assignments. - Proactively notify business areas
of regulatory requirements and changes, and assist the business
areas in coordination of implementation. - Build effective
relationships with state and federal regulators, as well as internal
business clients.
BACKGROUND/EXPERIENCE
Solid SERFF filing system experience is REQUIRED in order to be
considered for this position.
Exposure to multiple states for SERFF submissions.
Strong understanding of Group Insurance Specialty Products in
one or several of the following: Medical, Dental, Vision, Life,
Disability, Workers Comp or Student Health
In-depth knowledge of the regulatory insurance environment
Excellent written and verbal communication skills, and the ability
to interact effectively with different audiences
Manage work load effectively and within critical deadlines for
state filings.
Relationship management and negotiation skills in dealing with
state & federal regulators.
Microsoft Office Suite skills to include: Word and Excel
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
Supervisor, Clinical Health Services (RN-Medicare Advantage)
Requisition # 35750BR
Supvr, Bus Project Mgmt-San Antonio, TX
Requisition # 35733BR
POSITION SUMMARY
PLEASE NOTE, THIS IS A TELEWORK POSITION ONLY IN TEXAS.
This position is project management for the NT24 department
FUNDAMENTAL COMPONENTS:
Nurse management call center experience. Project management
experience.
BACKGROUND/EXPERIENCE desired:
Proven track record in meeting project milestones and negotiating
for resources.
Proven communication skills both written and verbal
Past positions required acting a project lead and directing a team
Proven ability to affect change/interpersonal skills
Solid Project Management and supervisory skills
EDUCATION
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is required
Management/ is desired
FUNCTIONAL EXPERIENCES
Nursing/Emergency Room/4-6 Years
Management/Management - Operations/4-6 Years
Project Management/Project Management Consulting/1-3 Years
Quality Management/Quality Management/1-3 Years
TECHNOLOGY EXPERIENCES
Call Management/CMS/4-6 Years/End User
Remote Access/Citrix/4-6 Years/End User
REQUIRED SKILLS
General Business/Communicating for Impact/ADVANCED
Leadership/Developing and Executing Strategy/ADVANCED
Leadership/Driving Change/ADVANCED
Supvr, Clinical Hlth Svc
Requisition # 35920BR
VOL Sales Director
Requisition # 33698BR
POSITION SUMMARY:
Sales, account management and business retention for Aetna
voluntary products and services in support of profitable growth
and other business objectives.
FUNDAMENTAL COMPONENTS:
Builds strategic partnerships with assigned producers and
customers to achieve profitable growth and cross-sell objectives
for assigned business or customer segments, products and
assigned geographies.
BACKGROUND/EXPERIENCE desired:
Minimum 5 years of notable group benefits sales experience
marked by proven success generating top and bottom line growth.
- Previous sales roles within respected insurance companies
and/or general agencies where he/she developed and executed a
successful business strategy that led to new business/revenue
outcomes.
- Demonstrated success over an extended period of time and with
client.
EDUCATION:
The highest level of education desired for candidates in this
position is a Bachelor's degree or equivalent experience.
FUNCTIONAL EXPERIENCES:
Functional - Sales & Service/Account Management/7-10 Years
Functional - Sales & Service/Distribution channel management/710 Years
Functional - Sales & Service/Individual sales/7-10 Years
Functional - Sales & Service/Strategy development/7-10 Years
TECHNOLOGY EXPERIENCES:
Technical - Aetna Applications/Aetna Sales Effectiveness Tool/1-3
Years/End User
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End
User
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End
User
REQUIRED SKILLS:
General Business/Managing Sales Relationships/MASTERY
Sales/Knowing Markets/MASTERY
Sales/Strategic Prospecting/MASTERY
DESIRED SKILLS:
Leadership/Collaborating for Results/ADVANCED
Leadership/Driving Strategic and Organizational Agility/MASTERY
Leadership/Engaging and Developing People/ADVANCED