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Aetna Utilization Management Implementation Senior Business Consultant in Philadelphia, Pennsylvania

Req ID: 61164BR

Job Description

This role is telework with 10-25% of travel required.

-Plan all aspects of complex utilization management (UM) implementation projects and other assignments

-Manage all project activities of multiple new and/or expansion health plan implementation projects

-Execute Franchise Model policies, procedures, workflows, systems and training materials and modify to incorporate contract/regulatory specific requirements for state regulatory approval

This dynamic cross-functional position offers the right candidate the opportunity to partner across Aetna's Medicaid business to support the CVS Aetna Government Services growth strategy by streamlining tools and processes, enhancing internal and external collaborative communication and delivering on Aetna's clinical products. If you are looking for a challenging opportunity on a newly developed team to use your clinical, strategic thinking, relationship building and consultation skills than this is the position for you.

Fundamental Components included but are not limited to:

-Manage all new and/or expansion of complex utilization management health plan implementation projects in collaboration with the Aetna Medicaid Implementation Leadership team.

-Manage project scope, and deliverables within specified deadlines while continuously assessing project change requirements in alignment with state contracts and change relative to the agreed scope.

Qualifications Requirements and Preferences:

-3+ years experience in utilization management is required

-3+ years of Medicaid experience is required

-3+ years experience with several of the following methodologies: management consulting, project consulting, business process consulting, strategic business planning, and/or risk management consulting required

-An RN or Licensed Social Worker or Counselor is preferred

-Experience with enterprise-wide and/or cross-functional large scale initiatives with high degree of complexity is preferred

-Demonstrated experience successfully implementing change in complex organizations is preferred

-Demonstrated superior business process, project management and organizational redesign experience is preferred

-Demonstrated leadership with relevant initiatives: Business process, enterprise business project management/consulting, strategic planning, risk management is preferred

-Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously is preferred

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

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.

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