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Position Summary
The Senior Manager Business Consultant supports Aetna Medicaid's value-based care strategy by partnering with provider organizations to improve quality outcomes, enhance member experience, and manage total cost of care. This role serves as a strategic advisor to providers participating in value-based and population health programs, using data analytics and performance insights to identify opportunities for improvement and drive measurable results.
The Sr, Mgr. Bus Consultant collaborates with provider leadership, physicians, and cross-functional teams to implement care coordination, care gap closure, quality improvement, and population health initiatives. Success in this role requires strong analytical, relationship management, and communication skills, along with experience supporting value-based payment models and provider performance improvement.
Required Qualifications
- Manage relationships with provider organizations participating in Aetna Medicaid's value-based care and value-based payment programs.
- Develop and execute provider engagement strategies that improve quality outcomes, member experience, and total cost of care.
- Lead provider performance improvement initiatives focused on quality, utilization, risk stratification, and population health outcomes.
- Analyze provider performance data, including quality metrics, utilization trends, cost of care, and high-risk member populations, to identify opportunities for intervention and improvement.
- Collaborate with network, clinical, population health, and technology teams to implement and support value-based care strategies.
- Support the development and expansion of accountable provider relationships and value-based payment arrangements.
- Partner with providers to improve performance in key areas such as care coordination, care gap closure, transitions of care, readmission reduction, and integrated care management.
- Facilitate performance review meetings with provider leadership and clinical teams to assess outcomes and develop action plans.
- Educate providers on value-based care programs, performance reporting, population health tools, and best practices.
- Promote adoption of innovative workflows, technology solutions, and data-driven interventions that improve quality and member outcomes.
- Identify opportunities to enhance care delivery through community partnerships, data sharing, and population health initiatives.
- Present provider performance results and strategic recommendations to provider and health plan leadership.
- Support implementation of new value-based payment models and Medicaid population health initiatives.
Preferred Qualifications
- 5-10 years of experience in healthcare, value-based care, population health, provider engagement, or managed care.
- Experience with value-based payment models, shared savings, pay-for-performance, and provider performance improvement.
- Strong analytical and business intelligence skills with the ability to interpret quality, utilization, cost, and provider performance data.
- Experience collaborating with provider executives, physicians, and practice leadership to drive outcomes and operational improvements.
- Knowledge of Medicaid, HEDIS, quality improvement, care coordination, and population health strategies.
- Strong problem-solving, decision-making, collaboration, and relationship management skills.
- Demonstrated ability to execute strategic initiatives, manage multiple priorities, and deliver measurable results.
- Growth mindset with the agility to adapt to change and support continuous improvement and development.
Education
• Bachelor's degree preferred/specialized training or equivalent work experience
Pay Range
The typical pay range for this role is:
$67,900.00 - $149,328.00
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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- Manage relationships with provider organizations participating in Aetna Medicaid's value-based care and value-based payment programs.
- Develop and execute provider engagement strategies that improve quality outcomes, member experience, and total cost of care.
- Lead provider performance improvement initiatives focused on quality, utilization, risk stratification, and population health outcomes.
- Analyze provider performance data, including quality metrics, utilization trends, cost of care, and high-risk member populations, to identify opportunities for intervention and improvement.
- Collaborate with network, clinical, population health, and technology teams to implement and support value-based care strategies.
- Support the development and expansion of accountable provider relationships and value-based payment arrangements.
- Partner with providers to improve performance in key areas such as care coordination, care gap closure, transitions of care, readmission reduction, and integrated care management.
- Facilitate performance review meetings with provider leadership and clinical teams to assess outcomes and develop action plans.
- Educate providers on value-based care programs, performance reporting, population health tools, and best practices.
- Promote adoption of innovative workflows, technology solutions, and data-driven interventions that improve quality and member outcomes.
- Identify opportunities to enhance care delivery through community partnerships, data sharing, and population health initiatives.
- Present provider performance results and strategic recommendations to provider and health plan leadership.
- Support implementation of new value-based payment models and Medicaid population health initiatives.
- 5-10 years of experience in healthcare, value-based care, population health, provider engagement, or managed care.
- Experience with value-based payment models, shared savings, pay-for-performance, and provider performance improvement.
- Strong analytical and business intelligence skills with the ability to interpret quality, utilization, cost, and provider performance data.
- Experience collaborating with provider executives, physicians, and practice leadership to drive outcomes and operational improvements.
- Knowledge of Medicaid, HEDIS, quality improvement, care coordination, and population health strategies.
- Strong problem-solving, decision-making, collaboration, and relationship management skills.
- Demonstrated ability to execute strategic initiatives, manage multiple priorities, and deliver measurable results.
- Growth mindset with the agility to adapt to change and support continuous improvement and development.
- Bachelor's degree preferred or specialized training or equivalent work experience.
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
