Network Performance Manager
Overall accountability for structuring and maintaining successful value based care collaborations and for the strategic alignment and operational success of assigned provider relationships with most complex/high value initiatives and/or highest risk and revenue generating provider systems, networks and relationships (i.e. value based).
Optimizes interactions, anticipates needs, and provides recommendations to providers and internal business partners to establish and maintain productive, professional value based relationships. Consults on operational design and implementation of the business strategy and executes the strategic vision and tone for the relationship and carries out the operational plan to execute that strategy. Influences and/or manages internal cross-functional groups and external client relationships and utliizes data in the management of patient populations to ensure that financial, technology, clinical, operational goals, provider satisfaction, cost targets, network growth, and efficiency targets are achieved. Educates internal and external parties as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, performance measurement techniques, policies, and procedures. Manages the development and execution of an annual strategic business plans and meeting with key providers to ensure service levels are meeting expectations. Collaborates cross-functionally to ensure optimal implementation of large provider systems, monitor and optimize performance including clinical, quality, capabilities, and growth as well as financial goals. Manages cost drivers and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution. Consult with providers to improve functionality, and enhance solutions, programs, products, services and technology to ensure better outcomes and achievement of program objectives. Accountable for the collaboration management services being delivered.
Demonstrated project and client management, strategic planning and proven ability to interact with, influence and collaborate with clients at all levels.
7+ years' experience with business segment specific policy, benefits, plan design and language and contract interpretation.
7+ years experience with several of the following methodologies: management consulting, project consulting, strategic analysis and planning, and/or risk management consulting.
Working knowledge of business segment specific codes, products, and terminology.
Bachelors Degree or equivalent combination of education and experience.
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.
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