Aetna Senior Business Consultant in Santa Ana, California
Req ID: 64564BR
office based in Woodland Hills, CA or Santa Ana, CA
Local quarterback with dual responsibilities in maintaining/improving market Stars ratings and risk adjustment; executes on STARS strategy as (local) extension to Segment best practices; resources dual responsibilities in maintaining/improving market Stars ratings and risk adjustment; executes on STARS strategy as (local) extension to Segment best practices / resources
Fundamental Components included but are not limited to:
Focused on quality performance, executing on national initiatives at local market level
Identify local market STARS and RAR strategies and manage local quality programs (
Manage and direct local vendors
Conduct data analysis, in conjunction with national tools, to identify opportunity areas and paths on track; assure member metrics being met
Oversees team of embedded coders with coordination from national team
Engage with clinical team and specific clinics, medical groups, hospitals; attends JOM meetings; Supports engagement managers and RN program managers as needed
Additional dock-in points needed to manage include MSO, product, sales, network, performance, MEU
Monitors and trends member complaints, grievances and appeals in the local market and creates mitigation plans.
Qualifications Requirements and Preferences:
3+ years of Medicare Advantage experience with heavy focus in STARS/Risk Adjustment areas
Fluent in Quality standard principles including Stars, HEDIS and Medicare Risk Adjustment
Ability to foster trust/relationships with internal partners and key provider groups
Ability to execute strategy and devise plans
Demonstrated leadership with relevant initiatives: Business process, enterprise business project management/consulting, financial strategic planning and analysis, strategic planning, risk management.
Experience with several of the following methodologies: management consulting, project consulting, business process consulting, financial strategic analysis, mergers and acquisitions, strategic business planning, and/or risk management consulting.
Masters degree preferred, but not required.
Additional Job Information:
Team leadership and team building skills.Analytical and planning skills.Negotiation/influencing skills.Relationship and change management skills.Organizational skills.Time management skills.Critical thinking skills.Oral and written communication skills.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Management
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.