Aetna VBC Network Management Lead in Phoenix, Arizona
Req ID: 67071BR
The Engagement Manager Lead role will report to the Chief Network Officer. He/she is responsible for securing new Value Based arrangements with Key provider organizations in both Arizona and Minnesota markets. The individual will also be responsible for coordinating all types of account servicing in order to implement and maintain value-based-contract (VBC) arrangements. This includes setup and on-going maintenance of tech / care management solutions, organizing consultative services and guidance from subject matter experts as needed, as well as back office functions such as billing, claims and appeals processing. He/she will interact with Market leadership and Key providers on a regular basis to handle provider requests and concerns while managing routine servicing operations to realize the terms of the VBC and responding to ad-hoc requests / issues raised by providers. He/she will coordinate cross-functional groups across ACS and the wider Aetna organization to carry out these servicing activities, many of which are not lead by groups within ACS (e.g., Medicity, Informatics). He/she works to ensure that the providers / ACOs are functioning successfully and the VBC arrangement is working to improve quality of care while reducing costs.
Fundamental Components included but are not limited to:
Ability to engage leadership at Key Provider Organizations assess current status and propose and implement the right VBC arrangement. Manages a cross-functional team of various Aetna, client and external resources to implement and maintain ongoing account services in VBC arrangements with combinations of financial, product, technology, clinical, and operational elements, ranging from infrastructure / network installation for provider solutions, ongoing maintenance of provider solutions (e.g., tech / population health services), payments / appeals processes, report generation, and compliance Establishes and maintains relationships across ACS and Aetna organizations to use as support for these provider servicing activities Manages servicing operations on a routine basis, including setting cadence for regular task activities, as well as responding to live direction requests from Engagement Managers Regularly interfaces with provider to facilitate implementation / maintenance of provider servicing activities and to respond to provider requests / concerns Ensures adherence to compliance policies and procedures throughout provider account operations, proactively identifying risks and escalating to leadership as appropriate Responsible for ensuring that provider account services contribute to ACS objective of improving quality of care while reducing costs
Qualifications Requirements and Preferences:
Proven ability to interact with, influence and collaborate with key providers and internal leadership at all levels. 5+ years in a role partnering with Providers in various Value Based arrangements. role 8+ years of client management 8+ years of hospital system and/or health insurance industry experience, ACO / managed-care experience preferredExperience managing matrixed staff with ability to leverage non-directs to complete tasks.Proven track record managing complex projects and or programs that resulted in cost savings.Good interpersonal and communication skills and ability to form strong client relationships.Knowledge of healthcare and insurance industry. Bachelor's Degree Required
Benefit eligibility may vary by position.
Job Function: Management
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.