Aetna Exec. Director, Mental Wellbeing Network in Fresno, California
Req ID: 66334BR
Aetna s Mental Wellbeing organization is looking for an Executive Director to lead our efforts to transform and innovate our mental and emotional health networks through the expansion of traditional provider partnerships and development of alternative networks and digital care offerings.
They will lead a team and be responsible for tying into our enterprise mental wellbeing strategy through:
Strengthening traditional provider partnerships
Providing easy access to care for our members
Expanding virtual care and digital therapeutic options
Extending alternative networks (peers, nonmedical)
Position Summary/Mission: The Executive Director will oversees a team of leaders and professionals responsible for ensuring overall network competitiveness and cost effectiveness across the country. Provides senior level leadership, guidance and oversight for all network management functions including provider contracting, strategic relationships, plan management and value-based strategies for business growth. The role will integrate provider network plans, activities, programs, policies and initiatives in order to effectively manage mental health costs while continually improving quality, access and customer satisfaction.
Fundamental Components included but are not limited to:
Responsible for the following functions:
Leads the design, development, management, and/or implementation of strategic network configurations that drive value and growth.
Oversees and/or negotiates the most complex, competitive contractual relationships with providers according to prescribed guidelines in support of enterprise and local network strategies to achieve cost effective reimbursement rates.
Builds and optimizes community-based partnerships with providers and other stakeholders.
Collaborates with partners in sales, underwriting, medical economics and clinical leadership to develop an effective market strategy, competitive pricing and discount position. Assesses opportunities for cost savings, alternate delivery models and financial risk sharing.
Provides network strategy support to sales and marketing and assistance with community relations to help achieve market and segment goals.
Supports sales and retention efforts through finalist presentations and engagements with clients, prospects, brokers and consultants. Develop and present ACO value proposition and performance results in sales meetings or to external constituents.
Provides a solid understanding and expertise in the end-to-end aspects of provider contracting, including contract modeling, configuration, utilization management, claims and analytics.
Ensures network adequacy and implements actions for network market expansion and to close gaps.
Understands and supports actions to address the complex regulatory environment of mental health.
Develops relationships and innovative provider models with progressive partners to drive high quality and manage costs. Advances the company strategy to adopt value-based payment models.
Drives improvement in market provider and member satisfaction results by partnering with medical management, marketing, finance and service operations. Responds to inquiries raised by various departments to resolve issues.
Develops, directs and maintains relationships with external and internal care providers. Manages local provider relationships and provider advocacy; representative at related external provider meetings and conferences.
Ensures high performing teams through employee selection, development and performance management.
Aligns with enterprise network functional areas
Required to communicate with internal and external parties by phone/in person; will require travel to offsite locations.
Qualifications Requirements and Preferences:
15+ years experience in managed care preferred
Multiple years experience leading and managing teams at all levels.
Proven strategic experience and ability to influence at the most senior levels.
Comprehensive understanding of mental wellbeing provider 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 traditional and alternative providers.
Strong experience building and maintaining relationships with provider groups.
A successful track record managing and negotiating major provider contracts that improve competitive position.
Knowledge of state compliance and regulatory requirements.
Proven ability to foster collaboration and operate in a heavily matrixed environment.
Solid leadership skills including staff development.
Finance - Delivering Profit and Performance
General Business - Maximizing Work Practices, Leadership - Developing and Executing Strategy, Leadership - Driving Change, Service - Creating a Differentiated Service Experience, Service - Working Across Boundaries, Technology - Leveraging Technology
Additional Job Information:
Job description may also be used for other products besides Commercial medical: e.g., Dental, Worker s Comp, Behavioral Health, Medicare, Medicaid, etc.; business systems & responsibilities mentioned in the description would align & reflect appropriate product, segment.
Benefit eligibility may vary by position.
Job Function: Healthcare
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.