Clinical Program Consultant

Job DescriptionHelp us elevate our member experience to a whole new level Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can be a part of a team that strives to have life-changing impact on our Medicare-Medicaid Plan (MMP) members. These individuals are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Position Summary/MissionThe Clinical Program Consultant, with an emphasis on Long Term Support Services (LTSS), will achieve clinical processes that impact both the delivery of services and the experience MMP members achieve, inclusive of vendor oversight. Vendors play a key role in the delivery of LTSS services. The Clinical Program Consultant plays a pivotal role in establishing the relationship with the vendor and ensuring the vendor's delivery of services meets the member's needs as determined by the member's care plan.Fundamental Components Reinforces clinical philosophy and accountable for maintaining vendor compliance with MMP and LTSS policies and procedures. Identifies opportunities to implement best practice approaches and introduce innovations to improve outcomes. Develops, initiates, monitors, and communicates performance expectations for the vendor. May act as a single point of contact for cross departmental communications and activities, which may include participation in customer meetings, implementation and oversight of market-level requirements regarding LTSS. Vendor oversight of all clinical management functions for Beneficiaries receiving LTSS including but not limited to: Assessment, service planning, care coordination, transition planning, consumer hearings, Beneficiary and caregiver education and training. Vendor oversight of all program management functions including but not limited to:o Vendor compliance with program requirements, rules and regulationso Vendor management of program policies and procedures and protocols that are aligned with federal and state requirementso Beneficiary complaint process; and Community education.Required Qualifications- 5 years of clinical experience - RN or MSW, LICSW with current unrestricted state licensure required- Must be willing to travel up to 5% once per year for auditsCOVID 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- Good analytical skills and data analysis experience - Excellent communication and customer service skills - Strong working knowledge of Microsoft Office ProductsEducationBSN preferred or if MSW, LICSW Master's Degree requiredBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-15