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Aetna Lead DSNP Operations Consultant (Telework, Non-Clinical) in Blue Bell, Pennsylvania

Req ID: 70008BR

Job Description

Manages the work and deliverables of DSNP program, through to implementation that impact multiple processes, systems, functions and products. This includes interfacing with operations to improve reporting, processes and accountability for the systems that support DSNP administration and clinical operations. This includes, but is not limited to, internal/external portal applications to ensure DSNP is displayed, communicated and visually correct. Portal applications would tie directly to internal training and ensure a seamless customer experience. Works collaboratively with all enterprise, Medicare, Medicaidm and functional areas that support or impact DSNP operations.

Fundamental Components included but are not limited to:

(*) Ensures that systems (administrative and clinical) are aligned with Medicare DSNP requirements (administrative and model of care), product and benefit designs, and state Medicaid agency contract requirements.

(*) Works with functional areas to ensure that systems and processes are appropriately configured to drive enrollment, claims, care management, customer and provider services, and member facing portals or tools.

(*) Lead must understand related operations and process that support these functions. Will support planning and implementation of DSNP integration and data sharing requirements.

(*) Collaborates and partners with other business areas across/within segments or other business areas to ensure all workflow processes and interdependencies are identified and addressed.

(*) Accountable to ensure all member internal/external portals are appropriately configured and displayed for all DSNP requirements. This includes, but is not limited to, accumulators, cost share displays, alignment with DSNP member materials, etc.

(*) Focus on operational processes, operational reporting, and improvements targeted to support our DSNP members' experience.

Qualifications Requirements and Preferences:

  • Previous experience (7+ years) in Medicare and leading strategic initiatives

  • Strong written and communication skills

  • Strong presentation and facilitation skills

  • Strong DSNP knowledge including: operations, enrollment, clinical and claims

  • Strong understanding of DSNP plans, regulations and SMACs

  • Ability to quickly identify gaps and recommend enhancements related to assigned areas.

  • Medicaid knowledge desired

  • Ability to lead and drive integration requirements across Medicaid and Medicare DSNP

  • Other work as assigned by the DSNP Program Office

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. Strong critical thinking skills. Oral and written communication skills.

Benefit Eligibility

Benefit eligibility may vary by 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.