CVS Health
Kansas City, Missouri, United States
Chief Network & Operations Officer
Posted over 1 month ago
Job Description
Job Description
The Chief Network Officer of our 7 state (CO,ND,SD,NE, IA,KS,MO), Heartland market will be accountable for leading and implementing Network strategy focused on optimizing network performance (Commercial and Medicare), driving a competitive cost position, delivering on strategic network goals and managing day-to-day operational components of the Heartland Network Management organization.
The Chief Network Officer is responsible for network and operational infrastructure aligned to cost related levers and ensuring the market network(s) meet cost metrics, adequacy standards, network compliance regulations, and profitability goals. Additionally, responsible for setting market network strategy and budget for contracting across all provider types and product segments, pushing innovation across traditional and non-traditional models for all lines of business, coordinating expansion activities, and driving towards local market and national goals. Manages their local market provider relations and directs implementation and operations of Value Based Contracting arrangements. S/he will continually evaluate Market "bottom line", manage medical costs in close partnership with Clinical Functions and drives change to improve cost structure partnership.
S/he needs to develop and maintain strong relationships with the Market President, Market CFO, Medicare GM and Sales Segment Leads in order to ensure alignment in developing and effecting strategies that drive profitable membership growth.
S/he will be responsible for developing the key messages and talking points to the external community and represent the Company at key meetings, conferences and negotiations.
Required Qualifications
Key expectations for this role are:
* Set the vision and goals for the market
* Create a customer focused culture and collaborates across the organization to ensure internal and external constituent needs are met
* Operate as a change leader suggesting new approaches to drive competitive cost positioning and network innovation; breaks down barriers across the organization in order to achieve results and drive innovation
* Establish a reputation in the local market as a thought leader and trusted business partner by provider, consultant, and employer stakeholders
* Create continuous organizational improvement around the network craft to include, commercial Medicare and Value Based Contracting competency
* Experience and comfort working with external audiences including C-suite level executives including facilitating meetings, delivering presentations and conducting negotiations with major provider systems
* Empower local Network leaders to be drive complex negotiations in their assigned geography
The leader will foster tighter alignment, integration and shared goals with the Markets organization and our national Network Strategy and Provider Experience organization. Additionally, s/he will manage a diverse team of highly skilled network market heads, network managers, contract negotiators and other professionals.
Responsibilities include but are not limited to oversight and leadership of the following:
* Network Management
o Overall accountability for outcomes and deliverables for the market including sales segment growth objectives
o Ownership of local market specific Medical Expense Reviews, unit cost trend forecasting, trend mitigation strategy, Value Based Contracting strategy, and unit cost management
o Ensure all contracting efforts with hospital/provider systems deliver appropriate outcomes
o Support enterprise initiatives that leverage CVS integrated assets (e.g., Health Hubs, Minute Clinics, etc.) o Close collaboration and alignment with internal Regional Medical Directors and Clinical teams
o Represent Aetna to the legislative, regulatory and community partners; improve public relations; and, manage regional public policy issues
o Active engagement in the development and assessment of internal policies impacting Providers and Network
o Coach, mentor, and manage performance of team members; drive talent development and actively build bench strength for key roles
o Ensure all operational teams deliver objectives
o Manage the department budget
o Establish strong partnerships and collaborative model with customers and prospective customers, National Network, Product, Clinical, Finance, Marketing, Actuarial, and Medical Economics across Commercial and Medicare segments to achieve objectives
The role reports to the Vice President, Chief Network Operations Territory Lead, North Central
Preferred Qualifications
Qualifications:
* A minimum of 15 years of healthcare experience including contracting, medical economics and field or national network experience
* A foundation of established professional healthcare relationships in the market and a strong understanding of the local market healthcare landscape and competitive dynamics
* Experience contracting with providers and hospital systems
* Strong presentation and communication skills; ability to consult as well as negotiate
* Strong analytical skills including root cause analysis
* Ability to think strategically
* Skilled at collaborating and working across a complex matrixed organization
* Management experience managing large, dispersed, highly skilled professional teams
* Expertise in market level management, cost drivers and levers, and knowledge of economic, regulatory and marketplace issues
Education
A Bachelors degree or equivalent experience required; a Masters degree preferred.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
The Chief Network Officer of our 7 state (CO,ND,SD,NE, IA,KS,MO), Heartland market will be accountable for leading and implementing Network strategy focused on optimizing network performance (Commercial and Medicare), driving a competitive cost position, delivering on strategic network goals and managing day-to-day operational components of the Heartland Network Management organization.
The Chief Network Officer is responsible for network and operational infrastructure aligned to cost related levers and ensuring the market network(s) meet cost metrics, adequacy standards, network compliance regulations, and profitability goals. Additionally, responsible for setting market network strategy and budget for contracting across all provider types and product segments, pushing innovation across traditional and non-traditional models for all lines of business, coordinating expansion activities, and driving towards local market and national goals. Manages their local market provider relations and directs implementation and operations of Value Based Contracting arrangements. S/he will continually evaluate Market "bottom line", manage medical costs in close partnership with Clinical Functions and drives change to improve cost structure partnership.
S/he needs to develop and maintain strong relationships with the Market President, Market CFO, Medicare GM and Sales Segment Leads in order to ensure alignment in developing and effecting strategies that drive profitable membership growth.
S/he will be responsible for developing the key messages and talking points to the external community and represent the Company at key meetings, conferences and negotiations.
Required Qualifications
Key expectations for this role are:
* Set the vision and goals for the market
* Create a customer focused culture and collaborates across the organization to ensure internal and external constituent needs are met
* Operate as a change leader suggesting new approaches to drive competitive cost positioning and network innovation; breaks down barriers across the organization in order to achieve results and drive innovation
* Establish a reputation in the local market as a thought leader and trusted business partner by provider, consultant, and employer stakeholders
* Create continuous organizational improvement around the network craft to include, commercial Medicare and Value Based Contracting competency
* Experience and comfort working with external audiences including C-suite level executives including facilitating meetings, delivering presentations and conducting negotiations with major provider systems
* Empower local Network leaders to be drive complex negotiations in their assigned geography
The leader will foster tighter alignment, integration and shared goals with the Markets organization and our national Network Strategy and Provider Experience organization. Additionally, s/he will manage a diverse team of highly skilled network market heads, network managers, contract negotiators and other professionals.
Responsibilities include but are not limited to oversight and leadership of the following:
* Network Management
o Overall accountability for outcomes and deliverables for the market including sales segment growth objectives
o Ownership of local market specific Medical Expense Reviews, unit cost trend forecasting, trend mitigation strategy, Value Based Contracting strategy, and unit cost management
o Ensure all contracting efforts with hospital/provider systems deliver appropriate outcomes
o Support enterprise initiatives that leverage CVS integrated assets (e.g., Health Hubs, Minute Clinics, etc.) o Close collaboration and alignment with internal Regional Medical Directors and Clinical teams
o Represent Aetna to the legislative, regulatory and community partners; improve public relations; and, manage regional public policy issues
o Active engagement in the development and assessment of internal policies impacting Providers and Network
o Coach, mentor, and manage performance of team members; drive talent development and actively build bench strength for key roles
o Ensure all operational teams deliver objectives
o Manage the department budget
o Establish strong partnerships and collaborative model with customers and prospective customers, National Network, Product, Clinical, Finance, Marketing, Actuarial, and Medical Economics across Commercial and Medicare segments to achieve objectives
The role reports to the Vice President, Chief Network Operations Territory Lead, North Central
Preferred Qualifications
Qualifications:
* A minimum of 15 years of healthcare experience including contracting, medical economics and field or national network experience
* A foundation of established professional healthcare relationships in the market and a strong understanding of the local market healthcare landscape and competitive dynamics
* Experience contracting with providers and hospital systems
* Strong presentation and communication skills; ability to consult as well as negotiate
* Strong analytical skills including root cause analysis
* Ability to think strategically
* Skilled at collaborating and working across a complex matrixed organization
* Management experience managing large, dispersed, highly skilled professional teams
* Expertise in market level management, cost drivers and levers, and knowledge of economic, regulatory and marketplace issues
Education
A Bachelors degree or equivalent experience required; a Masters degree preferred.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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