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.
Aetna is an Equal Opportunity, Affirmative Action Employer
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.
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.
Benefit eligibility may vary by position.
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