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Director, NY/NJ Medicare Initiatives

Primary Location: New York, NY
Additional Locations: CT-Hartford, NJ-Parsippany, NY-New York
The Director, NY/NJ Medicare Initiatives will support the business by recommending appropriate actions, strategies and/or alternatives to meet business needs. Has responsibility for leading/managing all aspects of a project and or program such as planning, coordination, development, implementation including the financial implications while prioritizing work, resources and time. Ensures the end state of the project and/or business operations meets business objective(s) and that all deliverables and due dates are met. Highly collaborative process often requires managing relationships across the segments or multiple functional areas.

Fundamental Components:
Accountable for leveraging local and corporate market and Medicare assets and overall company resources to drive cross-functional initiatives to meet the NY/NJ Strategic and Operating Plans for both Medicare individual and group plans. Provide market and competitive information, support, specialist resources, documentation, analysis needed to support the attainment of local and enterprise Medicare business objectives. Support development and improvement of NY Medicare customer experience, competitive position, corporate support/knowledge of NY Medicare strategy, sales and operations. Works closely with market based teams and corporate teams to ensure effective and efficient initiative management and results. Become a trusted advisor and key resource for NY/NJ Medicare related issues for Medicare corporate teams and local markets.
  • Proactively leads a program and/or most complex projects by setting strategic direction and leading execution
  • Stimulates strategic thinking in support of business direction
  • Independently manages all project and/or program management work including monitoring and tracking of progress and status update communications, such as rolling out new programs/ strategy to geographic area of responsibility
  • Leverages deep quantitative and qualitative data to ensure that strategy and decisions are powered by comprehensive and robust strategic analysis
  • Develops executive level analyses and presentation materials
  • Supports relationships with local and enterprise leaders and contacts
  • Organizes, leads and facilitates discussions to engage key players required to help local markets develop and execute their value-based strategies
  • Helps develop and drive territory and market-specific Medicare strategies and initiatives that lead to increasingly strong sales, quality and financial performance
  • Collaborates with Aetna’s market leadership and senior executives to develop business case and gain internal approvals
  • Works collaboratively with health plans, territories, and business segments on Medicare network related activities such as service area expansions, adequacy, compliance, audits
  • Communicates in a candid, transparent and persuasive manner, seeking others’ input and adjusting approach based on audience and the need
  • Leads NY Medicare work team meetings and ensures effective follow up and closure on work items; manages overall NY Medicare work plan initiatives and documentation
  • Drives NY Medicare initiatives using proven project management principles: sales, medical cost initiatives, customer retention, compliance, new vendor and quality initiatives.

Background Experience:
  • 10+ years’ experience and technical/functional expertise, with advanced knowledge in one or more of the following at a managed care or provider organization:
    • Managed Care Operations
    • Medicare Advantage
    • Network operations
    • Marketing/Sales
    • Finance
  • Proven project management skills
  • Proven track record of meeting project milestones and negotiating for resources
  • Demonstrated relationship management skills at a senior level and with external constituents
  • Experience developing executive level presentation materials
  • Strong analytical skills

Education and Certification Requirements:
  • Bachelor’s degree required
  • Master’s degree is a plus
  • Project Management certification and/or process improvement certification is a plus

Additional Job Information:
Team leadership and team building skills.Analytical and planning skills.Negotiation/influencing skills.Relationship and change management skills.Organizational skills.Time management skills.Critical thinking skills.Oral and written communication skills.

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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