Alpharetta, GA, United States
Clevel, Executive, Manager, 100k
Req ID: 58811BR
Design, develop, contract, maintain and enhance relationships with facilities, physicians and ancillary providers which serve as contractual networks of care for members; foster growth of managed care products; and enhance profitability of Aetna.
Responsible for network and operational infrastructure in the local market aligned to cost related levers and ensuring the market network(s) meet cost metrics, adequacy standards, network compliance regulations, and profitability goals.
Responsible for setting local market network strategy and budget for market contracting across all provider types and product segments, pushing innovation across traditional and non-traditional models for all lines of business, coordinating expansion activities, and driving towards local market and national goals.
Manages all local market provider relations and directs implementation and operations of Value Based Contracting arrangements.
Continually evaluates Market bottom line, manages medical costs in close partnership with Clinical Functions and drives change to improve cost structure partnership.
Ownership of local market specific MER, P-model, SAI, VBC strategy, and unit cost management.
Represents Aetna to the legislative, regulatory and community partners, improves public relations, and manages regional public policy issues.
Coaches, mentors, and manages performance of team members; drives talent development and actively builds bench for key roles.
Establishes strong partnerships and collaborative model with customers and prospective customers, National Network, Product, Clinical, Finance, Marketing, Actuarial, and MEU across Commercial and Medicare segments to achieve objectives.
Must possess a successful track record negotiating large, complex contracts.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Leadership/Act as company spokesperson to external constituents/4-6 Years
Functional - Leadership/Lead a business in different geographies or multiple markets/4-6 Years
Functional - Management/Management - Network Management/7-10 Years
Functional - Management/Management - Data analysis and interpretation/7-10 Years
Functional - Planning/Strategic - organization level/7-10 Years
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/4-6 Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/4-6 Years/End User
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
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 candidates'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: Health Care
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.
Website : http://www.aetna.com
Aetna Inc. operates as a diversified health care benefits company in the United States. The company operates in three segments: Health Care, Group Insurance, and Large Case Pensions. The Health Care segment provides medical, pharmacy benefit management, dental, behavioral health, and vision plans on an insured basis, and an employer-funded or administrative basis. This segment also provides Medicare and Medicaid products and services, as well as other medical products, such as medical management and data analytics services, medical stop loss insurance, workers' compensation administrative services, and products that provide access to its provider networks in select markets. This segment offers its products and services to multi-site national, mid-sized, and small employers, as well as individual customers. The Group Insurance segment provides life insurance products comprising group term life insurance, voluntary spouse and dependent term life insurance, group universal life, and accidental death and dismemberment insurance; disability insurance products; and long-term care insurance products, which offer benefits to cover the cost of care in private home settings, adult day care, assisted living, or nursing facilities. This segment provides insurance products principally to employers that sponsor its products for the benefit of their employees and their employees dependents. The Large Case Pensions segment manages various retirement products, including pension and annuity products for tax-qualified pension plans. The companys customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups, and expatriates. Aetna Inc. was founded in 1853 and is headquartered in Hartford, Connecticut.