Aetna SAI Management in Boise, Idaho
Req ID: 61010BR
Responsible for identifying, executing and monitoring trend mitigating initiatives across local network and medical management operations for the PNW market.
Project Management responsibilityfor the end to end process related to opportunity ideation and discovery,validation and analytics supporting all commercial and Medicare business segments.
Collaborates with Network, Medical Management, MEU, Finance andActuarial teams in the PNW to convert insights into data that is actionable.
Fundamental Components included but are not limited to:
Educates business and technical
resources on purpose and value of quality and cost metrics and assists in
interpretation to solve problems and improve outcomes
Monitors market level metrics and
performance for utilization, market level medical cost, premiums, financial
results, etc. to identify trends
Coordinates tracking and execution
of trend mitigating action items in collaboration with Network Management,
Medical Management and Medical Economics Unit (MEU)
Responsible for supporting the
network leader through the network strategy development process by leveraging
network design tools
Provides insights to Network
Management team to help inform network strategy based on insights and
Supports Medical Economics Review
process on behalf of Local Network team
Ability to effectively communicate
and negotiate across the business and in the external health care environment.
Provides leadership in negotiation
support and ability to influence sound business decisions based on data,
results and information derived from industry trends, research findings, and
Aetna-specific reports and analyses
Qualifications Requirements and Preferences:
5+ years experience in healthcare
Deep knowledge of health care
industry, policy, research design, statistical analyses, predictive modeling,
provider reimbursement methods, case-mix and risk adjustment methods and tools
Demonstrated experience developing
analysis, presentations and support material to successfully implement strategy
or change initiatives.
management skills at peer levels within an organization and external
Advanced technical, analytic and
consultative skills, extensive knowledge of health care data and information
systems, as well as an understanding of health care benefits, health care
financing and health care delivery systems
Advanced proficiency in excel and
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Planning
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.