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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.

**Qualified Candidates will be east coast based due to client**

The Senior Manager, Clinical Program Consultant  (CPC) serves as consultative strategic partner who would be dedicated to a National Account and provide reviews clinical data and trends, helps evaluate clinical program effectiveness and identifies clinical cost drivers. Analyze high-cost claimants and engage with medical directors and clinical resources as needed. Their primary goal is to make recommendations that help to improve the overall health of customer populations.

CPC partners with account teams to make recommendations for clinical programs that help mitigate medical cost trend and optimize return on investment. Have access market-leading analytic platform to support identification of key cost and utilization drivers, including medical and behavioral conditions in your population.

Responsibilities include but not limited to:

• Effectively collaborate with Field leaders, making certain to understand their business retention and growth objectives and how the work of the CPCs can best support those objectives.
• Work directly with customers in a strategic advisory role.

Required Qualifications:

We prefer CPCs who also have background and experience in well-being, healthcare consulting, client reporting and analytics, clinical operations and business management. We look for candidates with wellness certification (National Wellness Institute, Chapman Institute) and a background in patient engagement strategy and Clinically Integrated Network (CIN) development. We also look for important relationship building skills like leadership and collaboration.

• Collaborates with Aetna National Accounts Field Sales and Service staff to identify customers who may best benefit from Aetna’s medical, dental, pharmacy, behavioral health, and disability clinical management programs.
   
• For an assigned case listing, proactively evaluates and analyzes medical, dental, pharmacy, behavioral health, and disability trend drivers and proposes clinical programs and/or improvements to effectively manage these trends.
   
• In collaboration with existing Aetna account teams, consults with clients on trends identified within their employee base and works to tailor the most effective cost management strategy possible.

• Seeks to maximize clinical and financial outcomes for customers from the clinical programs and/or improvements recommended.
   
• Identifies and helps rectify clinical program gaps at customers who are utilizing Aetna clinical management programs to ensure best in class clinical management of members.

In collaboration with existing Aetna account teams, establishes and maintains proactive relationships with customers, consultants, vendors, and other external constituents.

• Proactively analyzes and presents complex clinical data to customers and consultants in a comprehensive and non-clinical format Interfaces with internal clinical, system, and reporting areas to ensure compliance with business requirements and specifications.
• Manages to completion a variety of ever-changing projects and priorities during the course of the year; effectively mitigates negative outcomes that may arise due the ever changing dynamics of the market and competitive landscape.
• Leads clinical/technical aspects of the delivery of multiple, complex projects that align with the customers strategic plan Delivers internal Aetna National Accounts training focused on clinical programs, through the preparation and presentation of materials related to medical management.
• Serves as a key resource on all clinical programs to all Aetna National Accounts staff.

Required Qualifications:

Requirements for our CPCs include an un-restricted RN/ LCSW license, with 7 years of diverse clinical and well-being experience. We also require healthcare industry experience, at least one year of wellness program management and a bachelor’s degree (master's level is preferred, or equivalent work expereince).

• Experience in healthcare industry, well-being, healthcare consulting, client reporting and analytics, clinical operations, and business management.

• Minimum 7+ years of diverse clinical and well-being experience.

• Ability to lead and collaborate across teams.

• Un-restricted RN/ LCSW license.

Education:

Bachelor's degree or relevant work experience.

Pay Range

The typical pay range for this role is:

$82,940.00 - $182,549.40

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.  This position also includes an award target in the company’s equity award program. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. 
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 03/23/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.