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Director, Network Management VBC

Primary Location: Los Angeles, CA
Additional Locations: CA-Los Angeles
This role will lead and manage a team focused on development of accountable care organizations and advancing the adoption of value-based quality of care networks, arrangements and payment models.

Provides leadership for the creation of VBC networks with contracts that will improve quality of care, manage costs and result in health improvements for our customers through collaborative relationships with facilities and providers.

Leads negotiations of complex value based contractual relationships with providers as well as ensures ongoing operational and cost efficiency.

Fundamental Components:
Manages a unit responsible for ensuring overall network competitiveness and profitability for a given geographical area or assigned provider type.

Complexity may vary by market size and the need to be organized around services such as hospitals, provider groups, providers or both; the type of contract, such as fee for service and/or value based, compliance functions and or cost management efforts.

Leads the design, development, management, and/or implementation of strategic network configurations and progressive managed care network relationships.

Leads a team of Managers, Consultants and Negotiators who design, develop, manage and/or implement strategic network configurations and effective managed care network relationships.

Leads value-based initiatives, programs, and projects in collaboration with national and local teams which may or may not report directly to them. Collaborate closely or/may share responsibilities with fee for service contracting.

Develops mutually beneficial end to end relationships with specified provider accounts by oversight of the implementation and operation of the VBC arrangement.

Works with Engagement managers (and others) to introduce and develop value based arrangements and progressive partnerships with key provider groups and relationships.

Develop and present ACO value proposition and performance results in sales meetings or to other external constituents as business development SME.

Effectively negotiates the most complex, competitive VBC contractual relationships with providers according to prescribed guidelines; initiates legal reviews as needed; ensure all required reviews completed by appropriate functional areas.

Supports regulatory filings in accordance with state and federal regulations as well as ongoing compliance requirements.

Analyzes data and is responsible for understanding medical cost issues and trends; collaborates with providers to improve performance of VBC arrangements; coordinate cross functionally with Medical Economics, National network and Engagement teams to recommend scorable action items.

Works closely with Population Health to enable and improve clinical outcomes.Manage Joint Operating Committee’s with providers on VBC arrangements.

Team ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and other inquiries/issues generated by the provider service center, provider data services.Required to communicate w/internal/external parties by phone/in person; may require travel to offsite locations.

Background Experience:
8 – 10 years related experience.

Related experience in health operations, network relations and development, command of financial and pricing strategies, and sales interface.

Experience building and maintaining relationships with provider systems and joint business development efforts.

Comprehensive understanding of health plan and provider financial issues; in depth knowledge of various reimbursement structures and payment methodologies.

Deep knowledge and experience with value based contracting and accountable care. Solid leadership skills, including staff development Bachelor's degree or equivalent work experience.

MBA/Masters degree preferred

Additional Job Information:
Job description may also be used for other products besides Commercial medical: e.g., dental, worker’s comp, behavioral health, Medicare, Medicaid, etc.; systems and tools mentioned in the description would align and reflect appropriate product, segment.

Potential Telework Position:

Percent of Travel Required:
10 - 25%

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

Benefit Eligibility:
Benefit eligibility may vary by 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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