Aetna Veterans Jobs

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Aetna Medicare Engagement Manager in Winchester, Virginia

Req ID: 63282BR

Job Description

Aetna Medicare is building partnerships with provider organizations through innovative insurance reimbursement models and redesigned care delivery programs and technology solutions focused on population health management. We are redefining how payers and providers work together and achieving the triple aim of improved patient experience, improved quality of care, and lower cost of care per capita.

Through active client management, systemic analyses, and consultancy, he/she ensures the achievement of financial, clinical, and operational Value Based Contracting (VBC) goals. He/she will interact with 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 and issues raised by providers and Aetna. He/she will coordinate cross-functional groups across the segment and the wider Aetna organization to carry out these servicing activities. He/she works to ensure that the providers and Medicare Provider Collaborations are functioning successfully and the VBC arrangement is working to improve quality of care while reducing costs. In addition, this individual is responsible for the development, coordination, execution and management of Medicare Network Provider Collaboration strategies in defined geographies to support Medicare Advantage growth and performance improvement opportunities.


Fundamental Components included but are not limited to:

Oversees the health plan/provider relationship for value based Medicare agreements across areas such as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity,operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence.

Drives success in the Aetna Medicare Provider Collaboration Program by: - Actively managing the relationships with the provider groups - Coordinating cross functional teams of care management, local market, and informatics to support critical engagement activities and to achieve and surpass performance targets - Continually improving quality and efficiency measures and performance - Defining and implementing enhanced operational, systems, and reporting requirements - Managing all contractual requirements support renegotiating complex collaboration and shared risk agreements to achieve desired engagement, quality, and financial outcomes.

Also 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:

Deep knowledge and expertise in Medicare Advantage

8+ years of hospital system and/or health insurance industry experience

ACO or managed-care experience preferred

10 years of client management

Proven ability to interact with, influence, and collaborate with clients at all levels

Ability to understand the needs of executives and help translate those needs into actionable plans

Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance within a Medicare value based agreement.

Comprehensive knowledge of Medicare policies, processes and procedures

Functional Skills:

Management - Management - Medicare, Network Management - Contract negotiation, Network Management - Provider relations

Benefit Eligibility

Benefit eligibility may vary by position. Click here to review the benefits associated with this 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.