Population Health Specialist - Kentucky Medicaid Health Plan

Aetna - Louisville, KY3.8

The Population Health Specialist (PHS) will be part of a high-performing team working in the local health plan market and be responsible for management of relationships with key providers tied to Aetna Medicaids value-based initiative. The PHS will serve as part of a dedicated national team that is responsible for carrying out our population health and clinical integration strategy.

Position is open to telework only in Kentucky and will work directly with our KY Medicaid Plan.

Fundamental Components:
  • Coordinate care and services between the local health plan care management and quality teams and our value-based solution (VBS) partners
  • Monitor analytics and utilization/quality/cost trends including high-risk and emerging-risk member identification and early identification of care intervention opportunities for our VBS and other key partners
  • Work across the provider and local care and service community to drive relationships and care coordination opportunities to ensure the full continuum of care is available to our members including building relationships with LTSS, behavioral health, pharmacy, home and community- based providers, patient-centered medical homes, health homes, community mental health centers
  • Lead the tactical and clinical execution of the local market value-based and population health care strategy working closely with national VBS team, network team, local health plan and technology vendor to build existing and establish new accountable provider relationships creating a common vision and care approach
  • Work with our provider partners and national shared services team to enhance, establish or refine provider workflows to create common procedures and protocols to best meet our members needs which include but are not limited to: readmission programs, transitions of care, quality gaps in care and of alignment with the health plan integrated care management team
  • Lead regular meetings with the provider clinical care teams to ensure optimal care coordination, program innovation, clinical decision making, contract execution and evaluation
  • Will provide partner education and adoption support for Aetnas population health management tools and processes reinforcing a member-centered approach and common approach to care coordination
  • Will seek out new opportunities to enhance, improve and optimize local care delivery and member engagement through clinical/social programming, data sharing or technology with community-based partners
  • Will participate with the larger population health and Medicaid Innovation team to continue on-going program design, development and evaluation
  • Will present outcomes of population health work at a local or national conference, symposia, or association meetings
  • Experience within an accountable care organizations and/or population health management within a provider organization or health plan
  • Experience with a new delivery model or healthcare transformation, patient-centered medical home, Centers for Medicare and Medicaid grant implementation etc.
  • Excellent written, verbal and presentation skills, equally comfortable presenting to the providers senior leadership, the local clinical teams or meeting directly with members in a care setting
  • Expert analytical and critical thinking skills desire to use analytics and data trends to drive care decisions
  • Executive ready to take on increasing responsibility and leadership roles as key accountable care provider partnerships evolve and mature
  • Expert project management skills- able to manage many relationships simultaneously and lead several initiatives- able to hit targets, deadlines and proactively establish day-to-day priorities
  • Expert collaborator and team-building skills able to take disparate systems and build, maintain and grow a high performing team and set of programs
  • Creative thought leader who finds a way to get to yes with achievable outcomes - able to keep focused and separate out the true signal in the noise- can overcome inertia, fear of change and uncertainty by keeping a positive focus and approach
  • Clinical background desired- advanced practice nurse, registered nurse, licensed clinical social worker- will also consider individuals with requisite experience who are not clinicians but who hold a Masters or Doctorate degree in public health, health organization leadership/change etc.
  • Experience with Medicaid, duals or special needs populations a plus
The highest level of education desired for candidates in this position is a Master's degree.

General Business/Communicating for Impact/ADVANCED
Leadership/Anticipating and Innovating/FOUNDATION
Leadership/Developing and Executing Strategy/FOUNDATION

Finance/Delivering Profit and Performance/ADVANCED
General Business/Consulting for Solutions/ADVANCED
Technology/Justifying the Business Case/ADVANCED

Telework Specifications:
Part-Time Telework (ex: 2 days office-based, 3 days telework); any work at home will begin after start date.

Are you a healthcare leader who wants to be on the cutting edge of healthcare transformation? Then consider joining Aetna Medicaid where we are building out an innovative team that is focused on creating a new coordinated and accountable system of care to deliver a healthcare experience second to none for our members we are privileged to serve through our local health plans.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

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