RN- Clinical Program Consultant ( Registered Nurse )

Aetna   •  

Chattanooga, TN

Industry: Managed Care & Health Insurance


5 - 7 years

Posted 382 days ago

Fundamental Components:

  • 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


  • RNdegreerequired
  • 5-10 years clinical experiencerequired
  • Clinical and financialexperience, including data analysis
  • Experience as a clinical program manager, an affordability nurses who have managed health care costs and or STAR experience would be ideal!
  • Strong Microsoft Office including Excel with pivot table knowledge
  • Analytical experience, experience in looking at trends and the ability to provide solutions to stop that trend
  • Empathy for the Senior population
  • Strong communication and client facing skills

The highest level of educationdesired for candidates in this position is a Bachelor's degree or equivalent experience.