Chief Network and Operations OfficerPrimary Location: Cary, North Carolina
Additional Locations: NC-Cary, NC-Charlotte, NC-Raleigh, TN-Nashville Apply
Market level senior leadership role responsible for ensuring that local provider network performance results meet the cost, adequacy, and compliance goals of the company. This includes oversight of the provider contracting and approval process, accountability for the most complex and challenging contractual relationships with providers, and working cross-functionally within the markets and nationally to ensure consistency with all contracting strategies. Maintains overall accountability for medical cost management within the local market geography.
- 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, leading 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 collaborative relationships with local market leaders, National Network, Product, Clinical, Finance, Marketing, - Actuarial, and Medical Economics Unit across Commercial and Medicare segments to achieve company and market objectives.
- Leads continuous organizational improvement to drive VBC competency and enhance provider experience.
- Expertise in market level management, cost drivers and levers, and knowledge of economic, regulatory and marketplace issues.
- Expertise in creating and leading Accountable Care and Population Health Management organizations.
- Advanced network capability, understanding of reimbursement methodologies and experience negotiating and interacting with large physician groups and hospital systems.
- Ability to clearly identify, articulate and execute on business strategies to reach market objectives.
- Ability to link strategic planning objectives to operational execution.
- Strong interpersonal skills with ability to work cooperatively to achieve overall organizational goals.
- Executive presence.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
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Additional Job Information:
At Aetna, our team members are passionate about growth, innovation and collaboration.
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.
58835Potential Telework Position: No Percent of Travel Required: 25 - 50%
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