Senior Manager Business Consultant

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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.

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