Lead Director, Network and Trend Optimization - West Region Remote

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Position Overview

Reports To: Executive Director, Region Development Officer

• Manages medical cost by partnering with Provider Contracting, MEU, Pharmacy, Claims Cost Management, Innovation, and Clinical to ensure aggressive management of medical cost trends to achieve the best price for our products and services.

• Connects internal and external relationships within the Commercial segment, across all Aetna shared services, to drive commercial medical development activities and frameworks to integrate business strategies across the Enterprise.

Job Summary

The Lead Director, Regional Network and Trend Optimization serves as a pivotal liaison between Network, Finance, Clinical Operations, and Sales Teams. This role is responsible for identifying and implementing opportunities to enhance cost efficiency and quality performance within the region. The incumbent will collaborate closely with the Network’s data and analytics teams to analyze healthcare cost trends and leverage resources effectively to maximize results. This role is responsible for collaborating with Network teams ensuring competitive provider networks, proactively monitoring healthcare cost and utilization trends. Additionally, this role will work with sales teams in top-tier priority markets to develop strategies that improve our network’s cost position and engage with commercial stakeholders.

Key Responsibilities

Strategic Collaboration

Act as the primary point of contact for the West Region between network, medical economics, clinical operations, finance team, and sales teams to align financial strategies with clinical objectives and market needs. Develop and execute strategic initiatives through pricing, network curation, and medical management that lead to sustainable long-term growth and revenue.

Market Network Strategies

• Develop and implement strategies to align with network contracting priorities with commercial trend management goals.

• Ensure the organization maintains competitive network arrangements to support cost-effective and high-quality care delivery.

• Serves as the primary point of contact between Network Contracting and Commercial Teams for the Region.

• Collaborate with network teams, and sales to improve cost positions in core markets.

• Leverage high-value networks and innovative payment models to enhance care affordability and access.

Medical Cost and Trend Management

• Identify and execute meaningful initiatives to mitigate trends and provide competitive products.

• Track and analyze industry trends and healthcare utilization benchmarks.

• Provide actionable insights to contracting teams to ensure strategic decision-making.

• Maintain rigorous discipline in reviewing and anticipating trends.

• Collaborate with Local Market Trend Committees and National Commercial Trend Committees.

Sales Collaboration

• Partner with sales teams in top-tier priority markets to develop strategies that improve our network’s cost position and support commercial objectives.

Key Stakeholder Engagement

• Participate in high-level meetings with network leadership and commercial stakeholders to present findings, propose initiatives, and drive decision-making processes.

• Act as a subject matter expert in network performance and trends for the Region.

Performance Reporting and Monitoring-

• Establish and oversee key performance indicators (KPIs) to track the success of implemented strategies and ensure continuous improvement. This position will play a pivotal role in achieving strategic priorities aligned with Aetna’s focus on:

  • Develop and deliver regular updates to leadership on network performance and trend analysis.

  • Create dashboards and reports that track progress toward achieving key performance indicators.

  • Supporting commercial stakeholders and priority market needs to align network cost strategies with growth objectives.

**We will consider candidates in any