Description
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. Aetna has an exciting opportunity to join its leadership team as an Executive Director, Network Management in the Downstate NY Market, which includes all of New York City, Long Island, Westchester and the Hudson Valley. This role develops the strategic direction and management of the day to day contracting and network management activities in Downstate New York market. This leader will manage a team but also be accountable for select provider relationships. The Downstate NY market is critical to the success of the organization as the largest market nationally in terms of membership and total provider spend across all segments. This role will ensure effective management of the medical benefit costs while continually improving quality, access, and client satisfaction for Aetna Commercial, Medicaid and Medicare membership Responsibilities: * Development and accountability for execution of the overall network and provider relations strategy for the Downstate New York Market. * Overall accountability for fee for service, value based, including at-risk arrangements, contracting and negotiations for all provider types including IPA/PHO, hospitals and hospital systems, ancillaries, and large physician groups. * Overseeing and/or negotiating the most complex, competitive contractual relationships with providers according to prescribed guidelines in support of enterprise and local strategies. * Negotiating complex contract language and initiating legal reviews as needed; ensuring all required reviews are completed by appropriate functional areas. * Initiate and maintain effective channels of communication with matrix partners including but not limited to, Claims Operations, Credentialing, Compliance, Sales and Marketing and Service. * Lead the design, development, management, and/or implementation of strategic network configurations that drive membership growth included targeted networks designed to support specific segment needs. * Build and optimize community-based partnerships. * Provide network strategy support to Client/Market teams. * Collaborate sales and retention efforts through finalist presentations and engagements with clients, prospects, brokers, and consultants. * Ensure network adequacy and compliance with regulatory requirements. * Advance the company strategy to adopt value-based payment models; coordinate with VBC network team and/or directly lead teams to develop, negotiate and manage complex Value Based and Accountable Care (ACO) relationships. * Represent the organization at related external provider meetings and conferences. * Work closely with Population Health resources to enable and improve clinical outcomes. * Responsible for understanding medical cost issues and medical cost ratios (MLRs) and initiating appropriate action to manage improvement initiatives and scoreable action items. * Review analytics with medical economics teams and work with providers to develop collaborative initiatives that improve quality results and manage costs. * Drive improvement in market provider and member satisfaction results by partnering with medical management, marketing, finance, and service operations. * Drive strategic goals/plan and message progress to CVS and Aetna C suite, including the resolution of barriers and engagement of decisionmakers. * Support completion of policy/legislative analysis and response to new regulations/legislation. * Prepare advocacy material for a variety of audiences. * Support CVS Health in attracting, retaining, and engaging a diverse and inclusive consumer-centric workforce that delivers on our purpose and reflects the communities in which we work, live, and serve. *Required Qualifications * The candidate will have a strong work ethic, be a self-starter, and have a proven track record of delivering results in a dynamic, collaborative environment. * Must reside (or relocate) to the Tri-State area. * 10+ years of experience in managed care; leading and managing teams. * Comprehensive understanding of hospital and physician financial issues and how to leverage technology to achieve quality and cost improvements for both payers and providers. * In-depth knowledge of various reimbursement structures and payment methodologies for both hospitals and physicians. * Solid understanding and expertise in the end- to-end aspects of provider contracting from modeling, configuration, utilization management, claims and analytics, including provider risk * Demonstrated experience with contracting for Commercial, Medicare and Medicaid lines of business. * Demonstrated success in developing and executing creative solutions with strategic provider partners in a complex and competitive market. * Demonstrated knowledge of providers in the local market including understanding the interrelationships and the competitive landscape. * Comprehensive understanding of value-based strategies and population health management. * Strong experience building and maintaining relationships with large hospitals/provider systems, integrated delivery systems and large physician groups. * People management skills including managing for results, attracting, and retaining talent and supporting individual development plans for colleague growth. * Understanding of the regulatory environment and experience maintaining contractual compliance with federal and state requirements. * Demonstrated a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias. * Commit to working in a hybrid model *Education* * Bachelor's degree or equivalent *Pay Range* The typical pay range for this role is: $131,500.00 - $303,200.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit [jobs.CVSHealth.com/benefits](https://jobs.cvshealth.com/benefits) CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work. CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [ColleagueRelations@CVSHealth.com](mailto:ColleagueRelations@CVSHealth.com) If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.
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