Overall accountability for the success of assigned Medicare value based provider relationships (VBC) in the MidSouth market (NC, SC, TN), including strategic alignment, deliverables, and financial and operational success, as measured by both the VBC and by Aetna. Reports to Medicare General Manager and manages internal cross-functional groups as well as the external client relationships to ensure optimal implementation and financial/clinical performance.
Responsible for leading all value-based performance aspects of the engagement/VBC relationship with a team of highly matrixed cross-functional resources. Manages internal cross-functional groups such as implementation, support, reporting, and enablement, as well as the external client relationships to ensure optimal implementation and performance.
Works with the VBCs executive leadership to ensure financial, technology, clinical, and operational goals are achieved. Responsible for coordinating the development and execution of an annual strategic business plan with Aetna Medicare General Manager and each VBC to exceed financial and other appropriate targets. Creates a mutually beneficial working relationship with various VBC provider partners by consulting on the clinical opportunities, operational design, and implementation of the business strategy while promoting the objectives of improving health care outcomes and increasing patient quality and value.
Develops and executes the strategic vision and tone for the VBC relationship and carries out the operational plan to execute that strategy. Seeks to optimize VBC interaction, anticipating VBC needs and acting as the voice of the VBC internally, providing recommendations based on VBC needs. Defines, organizes, influences, and/or leads a team of various internal, and external resources to implement newly negotiated arrangements; ensuring a smooth transition into the intricacies and requirements of the new relationship.
Collaborates cross-functionally to monitor and optimize VBC performance including clinical, quality, capabilities, and growth as well as financial goals. Looks for ways to enhance the solution within the assigned VBCs to include identifying new functionality, programs, products, services and technology to ensure better outcomes and achievement of program objectives. Has ultimate accountability for the VBC related engagement management services being delivered.
10+ years managed care / health insurance industry experience.
Multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes.
Proven track record managing complex projects and or programs that resulted in cost savings.
Experience managing large budgets.
Project management experience.
Demonstrated negotiation skills.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
General Business/Applying Reasoned Judgment/MASTERY
General Business/Ensuring Project Discipline/MASTERY
Leadership/Developing and Executing Strategy/MASTERY
General Business/Demonstrating Business and Industry Acumen/MASTERY
Leadership/Anticipating and Innovating/MASTERY
Leadership/Driving a Culture of Compliance/FOUNDATION
Option for Part-Time Telework (ex: 2 days office-based, 3 days telework) will be evaluated after a certain period of employment. Must live near a SC or NC office location, preferably Charlotte NC, Columbia SC or Cary NC.
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.
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