Executive Director, Network Management - Florida

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Position Summary

At Aetna, our health benefits business, we are committed to helping our members achieve their best health in an affordable, convenient, and comprehensive manner. Combining the assets of our health insurance products and services with CVS Health’s unrivaled presence in local communities and their pharmacy benefits management capabilities, we’re joining members on their path to better health and transforming the health care landscape in new and exciting ways every day.

Aetna has an exciting opportunity to join its leadership team as an Executive Director, Network Management supporting our Florida market for our Commercial, Medicare, IFP, and Medicaid businesses. In this role, you will provide leadership, guidance, and oversight for a team of directors, negotiators, and consultants to ensure overall network competitiveness, service, and profitability for given market or geographical area. You will oversee all network management functions including provider contracting, service, strategic relationships, plan management, and the value based contracting strategy for growth.

You will make an impact by:

• Leading and developing the overall network and provider relations strategy for given area of responsibility (ie. defined geographic area) and drives teams to execution.

• Leading the design, development, management, and/or implementation of strategic network configurations that drive membership growth.

• Leading and negotiating at the C-Suite level externally and internally in the payer arenas.

• Developing, directing, and maintaining relationships with external and internal care providers and their organizations. Building and optimizing community-based partnerships.

• Providing network strategy support to sales and marketing, along with assistance on community relations related items to achieve market and segment goals.

• Overseeing and/or negotiating the most complex, competitive contractual relationships with providers according to prescribed guidelines in support of enterprise and local strategies.

• Overall accountability for contract negotiations, involving all provider types including at-risk arrangements, IPA/PHO, hospital, and large provider groups.

• Providing a solid understanding and expertise in the end- to-end aspects of provider contracting from modeling, configuration, utilization management, claims and analytics, including provider risk sharing.

• Negotiating complex contract language and initiate legal reviews as needed; ensure all required reviews are completed by appropriate functional areas.

• Supporting sales and retention efforts through finalist presentations and engagements with clients, prospects, brokers, and consultants.

• Ensuring network adequacy and implementing actions to build out network expansion markets and/or to close gaps.

• Advancing the company strategy to adopt value-based payment models; coordinates with VBC network team and/or may directly lead teams to develop, negotiate and manage complex Value Based and Accountable Care (ACO) relationships.

• May oversee the negotiation, implementation, and management of VBC agreements.

• Leading the Joint Operating Committee meetings for VBC arrangements.

• Representing the organization at related external provider meetings and conferences.

• May have responsibilities related to Joint Venture alliances.

• Working closely with Population Health resources to enable and improve clinical outcomes.

• Responsibility for understanding medical cost issues and medical cost ratios (MLRs) and initiating appropriate action to manage improvement initiatives and scoreable action items.

• Reviewing analytics with medical economics and working with providers to develop collaborative initiatives that improve quality results and manage costs.

• Driving improvement in market provider and member satisfaction results by partnering with medical management, marketing, finance, and service opera