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Aetna is now a CVS Health Company

Medicare Provider Engagement Manager (64234BR)

Primary Location: Cary, NC
Additional Locations: NC-Cary, NC-Charlotte, NC-Durham, NC-Raleigh, NC-Winston-Salem
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 Chief Medicare Officer and manages internal cross-functional groups as well as the external client relationships to ensure optimal implementation and financial/clinical performance


Fundamental Components:
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.

Background Experience:
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. Supervisory experience. Demonstrated negotiation skills.

Required Skills:
Benefits Management - Interacting with Medical Professionals, Finance - Creating Profitable Partnerships, General Business - Applying Reasoned Judgment

Desired Skills:
Leadership - Developing and Executing Strategy, Service - Providing Solutions to Constituent Needs, Technology - Leveraging Technology

Functional Skills:
Clinical / Medical - Quality management, Communication - Communication Development - Executive level presentations, Leadership - Act as company spokesperson to external constituents, Leadership - Lead significant enterprise-wide initiative, Network Management - Provider relations

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft SharePoint, Desktop Tool - TE Microsoft Excel

Potential Telework Position:

Percent of Travel Required:
25 - 50%

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.

Click To Review Our Benefits (PDF)


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