Aetna Provider Engagement Manager – Medicare - 48776BR in Albany, New York
Req ID: 48776BR
Qualified candidates from anywhere in New York are encouraged to apply
Aetna Medicare is building partnerships with provider organizations through innovative insurance reimbursement models and redesigned care delivery programs and technology solutions focused on population health management. We are redefining how payers and providers work together and achieving the triple aims of improved patient experience, improved quality of care, and lower cost of care per capita. Medicare Collaborations specifically focus on Aetnas Medicare Advantage (MA) patients.
The Medicare Provider Collaboration Manager will report into the Local Market Medicare GM and will own accountability for several Medicare Provider Collaborations. The Provider Collaboration Manager is responsible for coordinating all types of account servicing in order to implement, maintain operations, and realize benefits according to the value-based contract (VBC) arrangement. Through active client management, systemic analyses, and consultancy, he/she ensures the achievement of financial, clinical, and operational VBC goals. He/she will interact with providers on a regular basis to handle provider requests and concerns while managing routine servicing operations to realize the terms of the VBC and responding to ad-hoc requests and issues raised by providers and Aetna. He/she will coordinate cross-functional groups across the segment and the wider Aetna organization to carry out these servicing activities. He/she works to ensure that the providers and Medicare Provider Collaborations are functioning successfully and the VBC arrangement is working to improve quality of care while reducing costs. In addition, this individual is responsible for the development, coordination, execution and management of Medicare Network Provider Collaboration strategies in defined geographies to support Medicare Advantage growth and performance improvement opportunities. Drive success in the Aetna Medicare Provider Collaboration Program by: - Actively managing the relationships with the provider groups - Coordinating cross functional teams of care management, local market, and informatics to support critical engagement activities and to achieve and surpass performance targets - Continually improving quality and efficiency measures and performance - Defining and implementing enhanced operational, systems, and reporting requirements - Managing all contractual requirements support renegotiating complex collaboration and shared risk agreements to achieve desired engagement, quality, and financial outcomes.
Deep knowledge and expertise in Medicare Advantage - 8+ years of hospital system and/or health insurance industry experience; ACO or managed-care experience preferred - 10 years of client management - Proven ability to interact with, influence, and collaborate with clients at all levels - Ability to understand the needs of executives and help translate those needs into actionable plans
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Network Management/Contract negotiation/7-10 Years
Functional - Network Management/Provider relations/7-10 Years
Functional - Management/Management - Medicare/7-10 Years
Functional - Management/Management - Data analysis and interpretation/7-10 Years
ADDITIONAL JOB INFORMATION
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.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Management