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A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Provider Partnership Director

Primary Location: Arlington, Texas
Additional Locations: TX-Arlington, TX-Dallas
Accountable for designing conceptual models, initiative planning, and negotiating high value/risk contracts with the most complex and challenging, market/region/national, largest group/system or highest value/volume of spend providers in accordance with company standards in order to maintain and enhance Texas Health Aetna Joint Venture provider networks, while working cross functionally to ensure consistency with all contracting strategies and meeting and exceeding accessibility, quality, compliance, and financial goals and cost initiatives.

Fundamental Components:
Fundamental Components/Job Description: Responsible for the creation, maintenance and oversight of strategic provider relationships and partnerships across all product lines, including shared savings, Value Based Arrangements and full risk arrangements. Including strategy development and execution of optimal provider contracts and ongoing maintenance. Provide day-to-day operations of Value Based Contracts including detailed analysis, reporting and recommendations for enhancement. Supports or assists with operational activities that may include, but not limited to data base management, credentialing support and contract coordination.

Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents are met and that escalated issues related, but not limited claims and accuracy of provider contract and demographic information are accurate and issues resolved in an expedient manner. Leads, develops and ensures execution a shared strategy across matrix partners (Network, Clinical Services, Operations and Sales) focused on improving efficiency, cost , market growth and satisfaction with Value Based provider partners. Acts as the primary resource for assigned, high profile providers or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.

Optimizes interactions with assigned providers and internal business partners to establish and maintain productive professional relationships. Including, but not limited to provider reporting, education, training and support on contract policies and procedures, plan design, compensation policies and technology to facilitate financial success and membership growth. .

Manages development of agenda, validates material and facilitates external provider meetings. Conduct and support provider recruitment, contracting, re-contracting activities through analysis and co-ordination with key business partners across the organization. Leads special projects, as assigned.

Strong communication, critical thinking, problem resolution and interpersonal skills.
7+ years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems.
Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.

The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

Claims background - desired
Managed Care background - desired
Communications background - desired
Healthcare Management background - desired

3+ years' experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation.
Working knowledge of business segment specific codes, products, and terminology.
3-5 years' experience with business segment specific policy, benefits, plan design and language.
Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills

Functional - Network Management/Provider relations/4-6 Years
Functional - Network Management/Provider data services/1-3 Years
Functional - Network Management/Contract negotiation/1-3 Years
Functional - Network Management/Credentialing/4-6 Years
Functional - Project Management/Cross-functional project management/1-3 Years

Technical - Aetna Applications//1-3 Years/
Technical - Network//4-6 Years/
Technical - Database//1-3 Years/
Technical - Desktop Tools//1-3 Years/

Telework Specifications:
4 days office based 1 days telework.

Be part of a dynamic team that bring innovative affordable solutions to the Dallas Fort Worth Texas market. This position is key in developing, nurturing and enhancing THA relationships with critical provider through collaboration and introduction of creative Value Based Solutions.

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.

Click To Review Our Benefits (PDF)


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