Aetna VA MCD Practice Trans. Consult in Richmond, Virginia

Req ID: 40510BR


Positions will be located in Richmond and Tidewater (Norfolk). The Practice Transformation Consultant (PTC) is a leader in the Medicaid plan focusing on integrating member care, clinical coordination, leading the development, implementation and ongoing monitoring of program and quality initiatives to address the needs of plan members. In partnership with plan integration, system of care and utilization management departments, they represent the plan at the practice level to facilitate medical and behavioral health integration, through practice compliance with Medicaid and Department deliverables, adherence to MLTSS requirements, and guiding population health management while meeting quality measures. With in-depth understanding of the plan integration vision they support and empower practices to perform at levels of integration excellence.

Fundamental Components:

Responsibilities include:

Partners with Integration, Integrated Care Management, System of Care, and Utilization Management leadership teams to provide overall vision and leadership across all Plan activities.

Serves as a key resource regarding any issues related to the integration of member care and practice compliance at assigned practices.

Comprehends all aspects of integrated practices (medical, behavioral health and wellness) including business and clinical and applies this knowledge through supportive relationships with assigned practices.

Establishment and monitoring of programs includes: 1. Communicate and coordinate with system of care team members and integration leaders 2. Serve as a resource for providers and their practices to facilitate integration, compliance with state, RHBA and contract requirements, patient centered medical home principles, quality care, population management and inpatient as well as emergency department usage reduction.

Supports the implementation of effective health care delivery by helping provider groups implement best/evidenced based practices that result in creation of health homes by sharing, interpreting, coaching and facilitating communication about quality, utilization and other medical management outcomes with practices in a way that helps deliver better care.

Trains providers on the use of tools to improve population health management, meet quality measures and decrease inpatient and emergency department service utilization as well as group training on integration topics such as Motivational Interviewing.

Has a comprehensive understanding of regulator deliverables, plan activities and goals, as well as licensing regulations and compliance. Communicates and applies them to all areas of practice operations including but not limited to the following: member care, peer and family, housing, occupational and rehabilitation case management and ACT teams.

Coordinates with plan integration management, care managers and care coordinators to assess practice needs. Collaborates with practice to develop and apply solutions to address these needs.

Demonstrates knowledge about providers contract and quality measures. Applies this knowledge to coach provider toward contract adherence and improvement on measures.

Project manages implementation and provides timelines for deliverables

Provides interprofessional practice support

Facilitates working groups


Background and Experience:

5-10 years of experience in a clinical setting to include 3-5 years of administrative experience, preferably in an integrated practice or FQHC; with strong consultative and communication skills, including public speaking experience. The PTC is a problem solver and innovator who has excellent negotiation and interpersonal skills.


The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.


General Business/Demonstrating Business and Industry Acumen/ADVANCED

General Business/Consulting for Solutions/ADVANCED

General Business/Maximizing Work Practices/ADVANCED


General Business/Communicating for Impact/ADVANCED

General Business/Ensuring Project Discipline/ADVANCED

General Business/Applying Reasoned Judgment/MASTERY


Education and Certification Requirements:

Preferred Masters degree in social work and license (LCSW) or Licensed Behavioral Health Clinician (LPC, LMFT, PhD, or

Psy.D) and or RN (BSN) with current unrestricted state licensure or Bachelor/Master level in Health Care Administration or


Additional Information:

Knowledge of managed care experience in working with managed health care benefits

Knowledge of governmental and regulatory authorities

Must have the ability to effectively work cross functionally with interdisciplinary teams including technical support teams

Must be able to analyze or interpret data, and have an understanding of NCQA standards or experience with quality improvement in a clinical setting

Critical thinking and problem solving skills

Must be able to analyze or interpret data, and have an understanding of NCQA standards or experience with quality improvement in a clinical setting

Working knowledge of Microsoft Word, Excel and PowerPoint software

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

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Job Function: Management