CVS Health

Ownership of local market specific MER, P-model, SAI, VBC strategy, risk adjustment, contract deviation and unit cost management.. Provide strategy and collaborate with medical management, medical policy development, pharmacy management, quality improvement, population health, provider network development, provider contracting and management, accreditation, and management of clinical delivery assets.. Oversee and ensure effective development and management of the provider network functions including provider development, provider relations, reimbursement, payment innovation, health care value transformation and network administration.. Setting market network strategy for fee for service contracting as well as value-based care/population health.. Develop and maintain strong relationships with the Market President, Market CFO, Medicare GM and Segment Leads in order to ensure alignment in developing and effecting strategies that drive profitable membership growth.

california

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. The Chief Network Officer for Aetna is responsible for the strategic and operational leadership and development along with implementation of network strategies and provider relations. Success will be measured by the executive’s ability to meet the organization’s growth, affordability, product, and the local market needs. This market leader will be responsible for the California market and report to a VP, Regional Network Leader. Key Responsibilities <ul><li>Led the team that is accountable for leading and implementing the Network strategy focused on optimizing local market network performance (Commercial and Medicare) and cost, delivering strategic network goals.  Ensure all contracting efforts with hospital/provider systems deliver appropriate outcomes  </li><li>Direct oversight of the provider network and responsible for managing the total cost of care for members and clients.</li><li>Ownership of local market specific MER, P-model, SAI, VBC strategy, risk adjustment, contract deviation and unit cost management.</li><li>Accountable for lowest cost contracting efforts across all provider types. Ensure alignment to core processes for contract administration for example, accurate and timely contract loads.   </li><li>Provide strategy and collaborate with medical management, medical policy development, pharmacy management, quality improvement, population health, provider network development, provider contracting and management, accreditation, and management of clinical delivery assets.   </li><li>Cultivating strategies to improve the health care experience for members and for improving the experience of providers.</li><li>Thought leader that fosters deep collaboration with providers to facilitate joint design of innovative health improvement, member engagement, care management, and other initiatives that result in exceptional value and quality outcomes.</li><li>Oversee and ensure effective development and management of the provider network functions including provider development, provider relations, reimbursement, payment innovation, health care value transformation and network administration.  Setting market network strategy for fee for service contracting as well as value-based care/population health.  </li><li>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.  </li><li>Sets the unit cost budget for contracting across all provider types and product segments, driving innovation across traditional and non-traditional models for all lines of business, coordinating expansion activities, and driving towards local market and national goals.</li><li>Manages their local market provider relations and directs implementation and operations of Value Based Contracting arrangements.</li><li>Manage medical costs in close partnership with Clinical Functions and drives change to improve cost structure partnership.  </li><li>Develop and maintain strong relationships with the Market President, Market CFO, Medicare GM and Segment Leads in order to ensure alignment in developing and effecting strategies that drive profitable membership growth. </li><li>Partner with sales to develop and execute customer specific network solutions to retain and win critical plan sponsors.  </li><li>Represent Aetna to the legislative, regulatory and community partners</li><li>Consult with the Market Compliance Consultant on state network filings and assign a network lead to support the filing</li><li>Active engagement in the development and assessment of internal policies impacting Providers and Network  </li></ul>Qualifications:  <ul><li>A minimum of 15 years of healthcare network & contracting experience.</li><ul><li>Medical Economics experience will be valued</li></ul><li>Proven people leadership skills</li><li>Strong understanding of the California market: capitation, delegation, and risk models required</li><li>Knowledge of Commercial and Medicare knowledge</li><li>Experience contracting with providers and hospital systems  </li><li>Strong presentation and communication skills; ability to consult as well as negotiate  </li><li>Strong analytical skills including root cause analysis  </li><li>Ability to think strategically  </li><li>Skilled at collaborating and working across a complex matrixed organization  </li><li>Expertise in market level management, cost drivers and levers, and knowledge of economic, regulatory and marketplace issues  </li><li>Possess exceptional leadership skills and transformational experience with a proven track record of delivering results.  </li><li>Must live in California or be willing to relocate </li></ul>Education Bachelors degree or equivalent Pay Range The Typical Pay Range For This Role Is $157,800.00 - $363,936.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | CVS Health We anticipate the application window for this opening will close on: 09/30/2024 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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