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Manager, Joint Venture Medicare Strategy & Business Development

Primary Location: New York, NY
Additional Locations: CT-Hartford, GA-Atlanta, MN-St Louis Park, NY-New York, VA-Falls Church
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Description:
Overview
To dramatically improve its relationships with hospitals, physicians and other providers, Aetna has established five joint ventures with leading hospital systems across the United States. Its mission is to develop mutually beneficial partnerships between Aetna and key providers, enabling their transformation from a hospital factory to a clinically integrated supplier of high quality, cost-efficient healthcare. Aetna has launched joint venture (JV) health plans with Banner (Arizona), Texas Health Resources (Dallas/Fort Worth), Allina Health (Minneapolis/St. Paul), and Sutter Health (San Francisco/Sacramento), all of which complement our flagship joint venture with Inova (Northern Virginia). In 2018, we introduced Medicare Advantage products at Innovation Health, our JV with Inova. In 2019, we introduced Medicare Advantage products at Allina Health | Aetna.

Working with the Senior Director, JV Medicare Strategy and Business Development, the Product Manager, JV Medicare Strategy and Business Development will support efforts to optimize performance of joint venture Medicare business. The work will be focused on three key areas:
  • Identifying Value Drivers: Determine the unique benefits created by operating Medicare business through a joint venture arrangement, as well as the the core competencies of each provider partner. Understand market landscape and competitive footprint to improve strategic positioning for each joint venture.
  • Improving Value Capture: Understand operating model and operations used to support Medicare business at each joint venture to identify and support execution of process improvement efforts for JV Medicare business. Analyze plan performance and determine product improvement opportunities relative to market needs and competitive landscape.
  • Communicating Value Story: Support efforts to help external stakeholders (e.g., prospects, members, brokers, providers) understand the unique benefits of each Joint Venture’s Medicare products and services. Support efforts to help internal stakeholders (e.g., joint venture leadership, Aetna Local Market, Aetna Medicare Segment, and Aetna Joint Venture Center of Excellence) understand Joint Venture Medicare business performance.
#LI-HH1

Fundamental Components:
Responsibilities
Identifying Value Drivers
  • Determine current and project future eligible Medicare population, MA enrollment rates by carrier and MA enrollment by plan. Analysis will be required for both existing service areas and potential service area expansion.
  • Research Medicare products delivered by companies operating under similar structure (e.g., integrated payer/provider systems, other companies operating as a joint venture).
  • Determine provider partner market share and performance relative to market competitors
  • Understand and document hospital system partner capabilities (e.g., clinical programs, locations, brand) to develop differentiated product strategy.
  • Understand and document core competencies of competitors (e.g., strong broker relations, efficient operations).
  • Research competitor plan offerings and monitor growth trends to understand key plan design elements in a given market.
  • Understand regulatory changes and potential impact to Medicare offerings.

Improving Value Capture
  • Understand and document current state processes for select joint venture Medicare business functions. Identify and document process variations against Aetna Medicare’s standard approach for each, respective function.
  • Understand and document select joint venture Medicare processes that involve provider partners (e.g., Stars, Risk Adjustment). Identify and document process variations against Aetna Medicare’s standard approach.
  • Build out new processes and/or redesign existing processes to help fully unlock value of joint venture Medicare business.
  • Identify opportunities to incorporate services that differentiate provider partners into joint venture Medicare plans. Assess potential product impact and potential medical cost savings. Determine implementation pathways (e.g., benefit change, vended service) for adding these services in a compliant fashion. Work with Aetna Medicare segment to assess feasibility of implementation approaches and create recommended path forward.
  • Analyze plan designs of competitors using standard tools and documentation review to determine relative strengths and weaknesses of joint venture Medicare plan designs.
  • Analyze existing portfolios across multiple dimensions (e.g., membership composition, financial performance, medical cost performance) to identify potential growth and performance improvement opportunities
  • Build recommendations to improve plan designs in line with identified value drivers. Support annual bid process working with local market, Medicare segment, and leadership teams at each joint venture.

Communicating Value Story:
  • Support development of materials to external stakeholders (e.g., member marketing, broker training materials, member presentations, provider communications) to ensure appropriate representation of identified value story in market.
  • Support development of materials to internal stakeholders (e.g., Joint Venture leadership teams and Boards of Directors, JV Medicare Steering Committee, Local Market teams) to drive consistent and accurate messaging around joint venture Medicare performance (both current and projected).
  • Support quality assurance (QA) efforts for joint venture Medicare products, as needed (e.g., website review, Summary of Benefits, Evidence of Coverage, Annual Notice of Change)
  • Build and manage JV-specific Medicare calendar
  • Build and manage workplans for initiatives led by JV Medicare Product team


Background Experience:
Desired Qualifications and Skills
  • Passion for transforming healthcare by breaking new ground and launching innovative Medicare solutions through a joint venture model
  • 3-5 years of healthcare industry experience in payers and/or providers
  • Solid understanding of health plan and health system business models and operations
  • Subject matter expertise in Medicare Advantage and/or EGWP business including familiarity with operations of core Medicare processes (e.g., Stars, Risk Adjustment) from both provider and payer
  • Familiarity with Medicare Advantage standard calendar and CMS publications and datasets
  • Ability to understand high-level impact of regulatory changes on joint venture Medicare business
  • Ability to work with large datasets - experience with member and/or patient level data preferred
  • Strong quantitative skills with ability to structure, analyze, and interpret data to identify trends and draw logical conclusions; propensity toward supporting hypothesis with strong quantitative and qualitative evidence; comfort developing business cases
  • Proven experience developing analyses, recommendations and roll-out approaches to successfully implement strategy or change initiatives
  • Demonstrated ability to understand current state processes, identify process improvement opportunities, and effectively manage stakeholders to execute change
  • Experience in operating in a highly matrixed environment, requiring the participation and support of multiple business functions
  • Demonstrated relationship management skills within an organization and with external constituents (e.g., customers, vendors)
  • Proficiency across Microsoft Office Suite including PowerPoint, Excel, Word.
  • Excellent verbal and written communication skills
  • Good meeting hygiene (e.g., notes, action items)


Additional Job Information:
Working on the Joint Ventures at Aetna 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, working in partnership with leading providers. We are inspired to make a difference, and to empower people to live healthier lives.

The ideal candidate will exhibit the following Behaviors:

Strategic Thinking: Drive towards multi-year strategy that differentiates each Joint Venture within the marketplace and align with customer and shareholder needs.
  • Develops and executes strategies in line with both enterprise and local growth plans
  • Anticipates emerging opportunities and threats
  • Balances resource requirements of multiple strategic priorities

Driving for results: Demonstrates urgency and holds self and others accountable for achieving high standards of performance and service
  • Anticipates when priority initiatives will be at risk and directs actions to address
  • Proactively identifies and completes work needed to move towards objective
  • Builds high quality materials and communications, big and small

Communicating for Impact: Communicates in a candid, transparent and persuasive manner, seeking others’ input and adjusting approach based on audience and the need.
  • Clearly articulates planned approach and solicits feedback prior to start
  • Positions ideas and proposals to satisfy the needs, interests and concerns of key stakeholders
  • Communicates and influences in a matrix environment across organizational boundaries


Potential Telework Position:
Yes

Percent of Travel Required:
10 - 25%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this 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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