Provider Engagment Manager - Medicare

Aetna   •  

Portland, ME

Industry: Healthcare


8 - 10 years

Posted 126 days ago

This job is no longer available.


This is a Full-time Telework position. Candidate needs to reside in Southern New Hampshire, Southern Maine, Northern Mass or Connecticut and be able to travel to territory in New Hampshire and Maine.

The Engagement Manager is a critically important roll within Aetna's value based contracting efforts. This position works daily with groups to convince them to first engage with the ideas of Value based contracting and then convinces them to change. It is a significant part of Aetna's future vision. Supports the business by recommending appropriate actions, strategies and/or alternatives to meet business needs. Has responsibility for leading/managing all aspects of a project and or program such as planning, coordination, development, implementation including the financial implications while prioritizing work, resources and time. Ensures the end state of the project and/or business operations meets business objective(s) and that all deliverables and due dates are met. Highly collaborative process often managing relationships across the segments or multiple functional areas.

Fundamental Components:
The Medicare Provider Collaboration Manager will report to the Director of Provider Engagement and will own accountability for multiple Medicare Provider Collaborations. These are the most important provider relations that Aetna has in the New England Market. The Engagement Manager is responsible for coordinating all types of account servicing in order to implement, maintain operations, and realize benefits according to the value-based contract (VBC) arrangement. Through active client management, systemic analyses, and consultancy, he/she ensures the achievement of financial, clinical, and operational VBC goals. He/she will interact / convince providers and their organizations to change from a Fee For Service model of reimbursement and care to a Value Based model based on payment for health and improvement of a population. The EM will meet with groups 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 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 will work collaboratively with the Aetna local and National Network, Operations, Sales and other teams in the development, coordination, execution and management of Medicare Network Provider Collaboration strategies in defined geographies to support Medicare Advantage growth and performance improvement opportunities. Drive 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 This position will also engage the Provider Collaboration groups with the Local Aetna Network teams in an effort to renegotiate complex collaboration and shared risk agreements to achieve desired engagement, quality, and financial outcomes.

7+ years experience with several of the following methodologies: management consulting, project consulting, business process consulting, financial strategic analysis, mergers and acquisitions, strategic business planning, and/or risk management consulting.
Experience with enterprise-wide and/or cross-functional large scale initiatives with high degree of complexity.
Demonstrated experience successfully implementing change in complex organizations.
Demonstrated superior business process, project management and organizational redesign experience.
Demonstrated leadership with relevant initiatives: Business process, enterprise business project management/consulting, financial strategic planning and analysis, mergers and acquisitions, strategic planning, risk management.
Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously.

The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

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