Health Care Business Consultant - RN

CVS Health; Raleigh (NC); Remote; USD 54,000 - 133,000; Full time

Job summary

CVS Health is seeking a Clinical Program Consultant to enhance health plan performance through clinical insights and recommendations. This fully remote position requires a Registered Nurse license and a passion for improving population health outcomes. The successful candidate will work collaboratively with Aetna partners and present quarterly findings to enhance member care.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings and counseling programs

Flexible work schedules

Tuition assistance

Qualifications

• Minimum of 3 years clinical experience, including 2 years in acute care.
• Unrestricted active Registered Nurse license required.
• Experience presenting to executive-level audiences.

Responsibilities

• Provide consultative clinical insights based on analysis of results.
• Recommend clinical programs that align with the customer's strategy.
• Collaborate across enterprises to drive goal alignment with customers.

Skills

Clinical analytic skills

Consultative skills

Problem-solving skills

Communication skills

Presentation skills

Education

BSN degree or equivalent work experience

Tools

Excel

PowerPoint

MS Office

Job description

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

** This is a fully remote opportunity, Travel to Aetna office and customer locations as needed in NORTH CAROLINA **

** MUST RESIDE IN EASTERN STANDARD TIME ZONE **

** Individual Contributor position**

Position Summary

Excellent opportunity for an experienced clinician with a passion for consulting and improving overall population health to leverage clinical, analytic, and consultative skills to join our team of Clinical Program Consultants (CPC) who offer clinical insights and solutions to help improve health plan performance for our group commercial plan sponsors. The CPC role is a highly collaborative position working proactively with the Aetna account team, Aetna’s Care management teams, and key Public and Labor partners to support our customers.

In this role, the consultant is empowered to:

• Provide progressive consultative clinical insights based on analysis of clinical plan utilization and impact of member behavior on medical plan costs.
• Recommend clinical programs and services that align with the customer's strategy and help drive short- and long-term results.
• Analyze, synthesize, and present clinical content with recommended actions to drive member behavior change and help improve plan performance in customer facing meetings.
• Act as a trusted clinical resource educating constituents about population health, industry trends, and impact of health disparities.
• Collaborate across the enterprise to drive goal alignment with customer and health plan.
• Provide input to customer’s population health strategy across the clinical spectrum.
• Create and propose solutions to improve member health including leveraging community opportunities and resources.

This is a customer-facing role with some travel to meet with customers and review plan performance, discuss recommendations, etc.

In this role, the consultant will:

• Provide consultative clinical insights based on analysis and identification of key drivers of results; includes analysis of high-cost claimants, transplants, etc.
• Recommend clinical programs and services that align with the customer's strategy and help drive short- and long-term results.
• Develop and present clinical content and recommendations in customer facing meetings e.g. present findings and recommended actions to help improve plan performance and clinical outcomes, and work collaboratively to help track and resolve issues
• Act as a trusted clinical resource; share current information about population health trends.
• Collaborate across the enterprise and with care management to understand gaps and identify opportunities.
• Provide input to customer’s population health strategy across the clinical spectrum.

Required Qualifications

• Unrestricted active Registered Nurse license.
• Travel to Aetna office and customer locations as needed in NORTH CAROLINA. (4-8 times per year)
• Comfortable presenting in front of executive level audience.
• Experience communicating for impact with large groups.
• Minimum of 3 years clinical experience (2 years in acute care, the other 1 year may be a combination of different sites of care including: hospital, clinic, and/or community health)
• Strong clinical analytic skills and demonstrated conceptual thinking. This includes utilizing Excel and other reporting mechanisms to support analysis.
• Strong problem-solving skills and attention to detail.
• Adept at communicating chronic conditions and impact on population health.
• Proficient consultative, communication and presentation skills (especially PowerPoint).
• Skilled at organizing and responding to multiple deliverables in a timely and professional manner.
• Ability to establish highly collaborative relationships within and outside the organization including at the executive level.
• Proficient with MS Office programs (Excel, PowerPoint, Word, and Outlook).

Preferred Qualifications

• North Carolina Resident
• 1+ years progressive leadership experience.
• Experience working with a Health Insurance Carrier.
• Experience with benefit plan design.

Education BSN degree preferred/specialized training/relevant professional qualification, or equivalent work experience.

Additional Candidate Information

This is a telework role with the expectation of time onsite with the plan sponsor in North Carolina or Virtually and travel as needed. Approximately 4-8 times per year.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $132,600.00

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.

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visithttps://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 07/04/2025

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