Bus Proj Program Sr Mgr

Aetna Inc. Johnson City , TN 37601

Posted 1 week ago

Job Description:

The DSNP Manager, MidSouth Market (NC, SC) reports to the Chief Medicare Officer and is accountable for overall performance of the DSNP product including growth and retention strategy, marketing and sales, network strategy and marketability, clinical outcomes, Stars, member experience and quality and financial performance in assigned markets. Develops and maintains effective relationships with appropriate state agencies, partners and community resources and is responsible for overall compliance with federal and state requirements. This is a highly collaborative role requiring ability to effectively work cross-functionally within the local market and with enterprise and Government Services teams as well as the DSNP Program Office to drive results and deliver on strategic year over year growth goals.

EEO Statement

Aetna is an Equal Opportunity, Affirmative Action Employer

Fundamental Components

Accountable for driving overall performance of DSNP product in MidSouth market including growth and retention, network, clinical outcomes, quality and financial performance.

Leverages and closely collaborates with local market, corporate, Medicare and other company resources to implement, optimize and achieve strategic, operational and financial objectives of the DSNP program.

Proactively leads the local market DSNP program by setting strategic direction and leading execution of complex projects through partnership with enterprise and national teams as well as the National DSNP Program Office. This includes:

  • Managing SMAC compliance

  • Supporting new market entry and ongoing state Medicaid agency engagement

  • Developing deploying and driving long-range strategic plans, objectives and tactics

  • Working with the sales team to establish sales and member retention strategies to drive growth and optimize retention

  • Collaborating with and providing training to local markets sales teams to drive sales, community lead generation and membership growth

  • Providing oversight and facilitation of performance management to drive market level improvement activities

  • Developing and introducing new and innovative products

  • Providing input and direction into product design and bid strategy

  • Participating in DSNP Network design, service area expansion, compliance audits, evaluation of network adequacy, development of provider reimbursement and education strategies/programs and provider performance, quality and engagement

  • Guiding development of member facing materials

  • Providing input and direction on care management and utilization management

Cultivates and maintains long term key stakeholder relationships with appropriate local and state agencies and community resources to support activation of those relationships with sales and community outreach initiatives.

Identifies trends, improvement opportunities and challenges and builds solutions to address them.

Works with Stars and Quality Lead to ensure that the DSNP program is exceeding quality standards and contributing positively to Stars outcomes

Serves as subject matter expert regarding Medicaid policy for dual eligibles in assigned market including but not limited to eligibility, Medicaid programs and services, benefits, etc.

Develops actionable strategies, and dashboards to gain a competitive advantage and determine best means to communicate and collaborate with existing clients.

Background Experience

10+ years' experience and technical/functional expertise, with advanced knowledge in one or more of the following at a managed care or provider organization: DSNP programs, Managed Care Operations, Medicare Advantage

Proven track record of driving cross-functional results meeting project milestones across an organization with multiple stakeholders.

Demonstrated relationship management skills at a senior level and with external constituents

Skilled and experienced at leading cross-functional work and teams

Proven experience leading transformational change in a competitive consumer product market.

Demonstrated leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes.

Ability to develop and execute strategy with proven record of accomplishment managing complex projects and/or programs that resulted in cost savings.

Experience working in a complex matrixed organization.

Experience working with external healthcare providers or health systems.

Experience managing large budgets.

Project management experience

Demonstrated negotiation skills

Proven experience influencing and managing through others.

#LI-DI1

Benefits Program

Benefit eligibility may vary by position.

Candidate Privacy Information

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.

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Bus Proj Program Sr Mgr

Aetna Inc.