Aetna Health Service Manager in New York, New York
Req ID: 63967BR
Office-based position in New York City.
Come join Aetna Digital! We are looking for an experienced clinician with an analytics background to contribute to the creation and maintenance of the CareEngine – Aetna s evidence-based clinical analytics platform. The candidate will play an integral role in the development of evidence-based content, clinical analytics and decision support algorithms. The candidate must possess a strong background in the use of clinical informatics and setting up clinician workflows to support clinical decision support and quality algorithms. This involves reviewing clinical literature from many sources, interpreting impact to our analytics platform, translating evidence-based recommendations into clinical rules, and presenting recommendations to a committee of board-certified physicians, pharmacists and registered nurses. These activities require advanced clinical, technical, analytic and consultative skills, extensive knowledge of health care data and information systems, as well as an understanding of epidemiology, health care benefits and health care delivery systems.
Fundamental Components included but are not limited to:
Research, review and present medical literature to a clinical committee for the updating and development of clinical decision support analytic rules. Collaborate with Board-Certified physicians, pharmacists, registered nurses, clinical operations and IT on product design, development and testing.
Review and update of ICD, CPT, NDC, LOINC, HIE, and ADT codes in the database to maintain compliance with external mandatory regulations. Partner with product management and account management to configure and enhance care management and consumer facing product suite.
Investigate inquiries from clinical operations regarding the program and member-level questions.
Support the implementation of clinical products via configuration in our account administration system
Support non-clinical digital product teams as a clinical SME
Assisting IT and QA team in completing clinical systems testing.
Participate in continuing educational activities, as appropriate.
Qualifications Requirements and Preferences:
RN licensure or Licensed Pharmacist required
5+ years clinical experience or managed care experience required
Ability to search, analyze and synthesize clinical literature
Proactively builds and maintains internal and external key relationships.
Capable of developing and delivering of analytical solutions in support of healthcare business initiatives that drive the short and long-term objectives.
Ability to perform and manage multiple activities and changing priorities.
Ability to work independently and adapt to team approach as necessary.
Ability to handle an environment with rapidly changing priorities
Strong organizational and detail-oriented skills.
Strong oral, written and interpersonal skills.
Nursing - Registered Nurse (RN), Pharmacy - Licensed Pharmacist
Clinical / Medical - Clinical claim review & coding, Clinical / Medical - Consultative informatics, Clinical / Medical - Disease management
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Consulting for Solutions
Leadership - Anticipating and Innovating, Leadership - Collaborating for Results, Technology - Selecting and Applying Technology Solutions
Additional Job Information:
Previous experience related to medical billing in a hospital or health system.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Healthcare
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.