Senior Clinical Program Consultant (CPC)

Job DescriptionExcellent opportunity for an experienced clinician with a passion for consulting and improving overall population health to leverage clinical, analytic, and consultative skills to join our team of Clinical Program Consultants (CPC) who offer clinical insights and solutions to help improve health plan performance for our group commercial plan sponsors. The CPC role is a highly collaborative position working proactively with the Aetna account team, Aetna's Care management teams, the Plan Sponsor Insights organization and key enterprise partners to support our customers. This is a clinical transformation-type role to support clients with ACO-like needs; experience with joint ventures, provider collaboration, or Accountable Care organizations required. Highly collaborative, individual contributor position in a professional environment working with the account team, customer and ACO, Aetna's clinical operation teams and our Aetna Plan Sponsor Insights team of consultants.Key components of the role include advanced analytics, clinical reporting, plan performance analysis and advanced knowledge of population health strategies to improve plan performance. In this role the consultant will perform the following: Provide consultative clinical insights based on analysis and identification of key drivers of results; includes analysis of high-cost claimants, transplants, etc. Recommend clinical programs and services that align with the customer's strategy and help drive short- and long-term results. Develop and present clinical content and recommendations in customer facing meetings e.g.e.g., present findings and recommended actions to help improve performance and clinical outcomes, and work collaboratively to help track and resolve issues Act as a trusted clinical resource; share current information about population health trends. Collaborate across the enterprise and with care management to understand gaps and identify opportunities. Provide input to customer's population health strategy across the clinical spectrum. Leverage advanced industry and clinical knowledge and the ability to leverage resources to turn data into actionable and measurable opportunities for the customers we support. This is a customer-facing role with peak travel throughout the year which is estimated at ~50-75% (pre-pandemic). Adjustments will be made to accommodate post-pandemic requirements and customer return-to-office strategies. Currently all work is performed virtually. This is a virtual work from home position except for any required customer travel. Clinical Program Consultants are key members of the Plan Sponsor Insights (PSI) business - a business focused on providing insights and solutions based on analytics to customers in the group commercial business. The work environment supports and thrives on out-of-the box thinking, creative talent and a consultative approach. Our team consists of physician, clinical, well-being, and analytic consultants. Our support is highly valued by our internal partners as well as the customers we serve.Required Qualifications- Minimum of 5 years clinical experience (3 years in acute care, the other 2 years may be a combination of different sites of care including: hospital, clinic, and/or community health) - Minimum of 7 years of combined experience in: wellness healthcare consulting, client reporting and analytics, clinical operations, business management. -5 years leadership experience; and/or any combination of education and experience, which would provide an equivalent background. -3+ years of utilizing Excel and other reporting mechanisms to support analysis.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Experience working with a Health Insurance Carrier Experience with benefit plan design Strong clinical analytic skills and demonstrated conceptual thinking Strong problem-solving skills and attention to detail Experience communicating for impact; driving change Excellent consultative, communication and presentation skills (especially PowerPoint); ability to take complex content and facilitate understanding for the audience Familiar with VBC reporting for ACO/JV Comfortable with organizing and responding to multiple deliverables in a timely and professional manner Ability to establish highly collaborative relationships within and outside the organization including at the executive level Proficient with MS Office programs MSN preferred CCM certification preferred If candidate is not currently WELCOA certified they will need to be complete this certification through Aetna once in the role.Education- Registered Nurse (RN) Unrestricted License Required. - BSN requiredBusiness OverviewAt Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2025-09-06