Aetna Exec Dir, Value Based and Medi in Blue Bell, Pennsylvania
Req ID: 51325BR
This critical role will be accountable for facilitating the development of market network strategy and leveraging Value Based Solutions (VBS) and Medicare assets and overall company network resources. This individual will provide information, support, specialist resources, expert opinion and thought leadership needed to support the attainment of local and enterprise network business objectives. They will also be responsible to lead negotiations and development of Collaborations, Advance Physician Partnerships and/or Joint Venture Health Plan or RBE relationships.
Develop partnership guidelines and leverage enterprise best practices for providers with innovative models or national scope. Become a trusted advisor and key resource for all provider network related issues for an identified geographical region.Fundamental Components:- Stimulates strategic thinking in support of business direction.
Helps develop and drive territory and market-specific Medicare, Value Based Contracting (VBC) and Joint Venture strategies that lead to increasingly accretive arrangements.
Leverages deep quantitative and qualitative market intelligence to ensure that network strategy is powered by comprehensive and robust strategic analysis.
Collaborates with Aetnas market leadership and senior executives to develop business case and gain internal approvals
Serves as point to identify and close gaps in organization capability/support inhibiting attainment of network performance and growth potential.
Works collaboratively with health plans, territories, and business segments on Medicare network related activities such as service area expansions, adequacy, compliance, audits.
Rolls out new programs/strategy to market (e.g., bundled reimbursements, delegation, capitation).
Establishes or manages relationships with senior executives and strategic/innovative providers or joint venture targets, cultivating a preferred payer status for Aetna Identifies and develops innovative provider partnerships and leverages them to attain disproportionate share growth.
Owns end-to-end negotiation of multi-state and/or complex arrangements such as joint ventures
15+ years leadership experience and technical/functional expertise, recognized as an expert in one or more of the following at a payer, managed care or provider organization: Network development/management, network operations, consulting, mergers and acquisition, finance, Medicare Advantage
7+ years experience with value based contracting from a payer or provider perspective
Proven knowledge and experience in commercial and government programs including Medicare and/or Medicaid Management of enterprise-wide and/or cross-functional large scale initiatives Solid understanding of hospital and physician practices operations and business models
Demonstrated experience successfully implementing change initiatives
Demonstrated sales and/or relationship management skills at a senior level and with external constituents
Demonstrated ability to develop and drive enterprise strategies for complex problems/ opportunities and to communicate and gain approval from senior leadership.
Candid, transparent and persuasive communication manner, seeking others input and adjusting approach based on audience and the need.
MBA/Masters degree strongly preferred, Bachelors degree required
Functional - Network Management/Contract negotiation/More Than 10 Years
Functional - Management/Management - Network Management/More Than 10 Years
Functional - Planning/Planning & performance management/More Than 10 Years
ADDITIONAL JOB INFORMATION
We are pioneering the transformation of healthcare by partnering with our local markets to create the best possible member and provider experience. Our expertise in aligning market needs with network solutions, execution, and measurement, differentiates our support to providers, producing healthy outcomes that are the envy of the industry.
Our multidisciplinary team of experts provides and uses the most advanced tools, education, data and insights to effectively manage performance. Our programs engage strategic providers in improving the health of local communities while driving our top line growth.
With our passion for personal growth and innovation, we integrate Medicare and Commercial expertise to fuel Enterprise growth and shape the future of Value Based Solutions (VBS.) With trust, transparency, accessibility and timely communication, we personalize our relationships with local markets and providers to build a healthier world.
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: Customer Service