Proactively leads a most complex provider negotiations by setting strategic direction, negotiating favorable full risk deal terms, documenting resulting arrangements in the provider contract.
Identifies gaps and recommends enhancements related to new and/or existing products, services and workflows based on broad view of the organization.
Collaborates and partners with other functional managers, other business areas across/within segments or other business areas to ensure all workflow processes and interdependencies are identified and addressed.
Consults with constituents (these may be internal and/or external) to scope/define project.
Influences change in order to improve performance results, organization effectiveness and/or systems/quality/services.
Obtains financial support for most complex projects or supports this work as it relates to program management.
Collaboratively works across multiple functions and /or segments to obtain agreement from all impacted parties (e.g., up and downstream effects often impact multiple functions and/or segments.
Responsible for development and implementation of new ideas that supports work/team.
Cross function/segment group facilitation/presentation. Leads all project and/or program management work including monitoring and tracking of progress and status update communications.
Responsible for resource utilization within and across work teams.
Responsible for the financial implications of contracts and/or program budgets.
Assists others to identify solutions to issues that negatively impact providers or ability to secure good terms.
This role is fully remote - can sit anywhere in the US
Background Experience Desired
8-10 years of Medicare Advantage, Managed Care Organization experience
Extensive knowledge of MA to include risk coding, STARS measures, CMS bid strategy
Proven project management skills.
Experience includes development and management of multiple priorities, leading multiple complex negotiations at a time
Proven negotiation skills including extensive experience leading Medicare Advantage percent of premium/delegation deals
Proven track record in meeting project milestones and negotiating favorable terms
Ability to communicate effectively with all levels of management.
Proven ability to satisfy customers needs and develop alternatives to resolve issues
Bachelors required, Masters preferred
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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