AVP, Chief Network Officer: Mid-South

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

The Chief Network Officer for Aetna is accountable for strategic and operational leadership, the development and implementation of network strategies and for cultivating positive relationships with local market providers. Success will be measured by the executive’s ability to meet the organization’s growth, affordability, product, and the local market needs. This market leader will be responsible for the Mid South Territory (North Carolina, South Carolina, Tennessee, Alabama, Mississippi) and report to the VP, Regional Leader – Southeast

Key Responsibilities:

• Lead the local Network teams accountable for implementing the Network strategy with a focus on optimizing network performance and delivering competitive costs in alignment with strategic objectives.   

• Direct oversight of the provider network and responsible for managing the total cost of care for members and clients.

• Ownership of local market specific unit cost targets, medical cost strategies, negotiation, and administration of VBC contracts, risk adjustment and contract deviation

• Accountable for lowest cost contracting efforts across all provider types. Ensure adherence to core operational processes for contract administration, accurate and timely contract loads.   

• Provide strategy and collaborate with medical management, medical policy development, pharmacy management, quality improvement, population health, provider network development, provider contracting and management, accreditation, and management of clinical delivery assets.   

• Cultivating strategies to improve the health care experience for members and for improving the experience of providers.

• Thought leader that fosters deep collaboration with providers to facilitate joint design of innovative health improvement, member engagement, care management, and other initiatives that result in exceptional value and quality outcomes.

• Oversee and ensure effective development and management of the provider network functions including provider development, provider relations, reimbursement, payment innovation, health care value transformation and network administration.  Setting network strategy for fee for service contracting and value-based care/population health.  

• Responsible for network and operational infrastructure aligned to cost related levers and ensuring the market network(s) meet cost metrics, adequacy standards, network compliance regulations, and profitability goals.  

• Sets the unit cost budget for contracting across all provider types and product segments, driving innovation across traditional and non-traditional models for all lines of business, coordinating expansion activities, and driving towards local market and national goals.

• Manages their local market provider relations and directs implementation and operations of Value Based Contracting arrangements.

• Manage medical costs in close partnership with Clinical Functions and drives change to improve cost structure partnership.  

• Develop and maintain strong relationships with the Market President, Market CFO, Medicare GM, and Segment Leads to ensure alignment in developing and effecting strategies that drive profitable membership growth. 

• Partner with sales to develop and execute customer specific network solutions to retain and win critical plan sponsors.  

• Represent Aetna to the legislative, regulatory and community partners

• Consult with the Market Compliance Consultant to support state network filings and other compliance deliverables

• Active engagement in the development and assessment of internal policies impacting Providers and Network  

Location: Must live within region with preference for North Carolina or Tennessee.

Qualifications:  

• 12+ years of healthcare network & contracting experience.

  • Medical Economics experience will be valued

• Proven people leadership skills

• Strong understanding of fee for service and value-based contracting with all provider types

• Knowledge of Commercia