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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.

Position Summary:

At Aetna, our health benefits business, we are committed to helping our members achieve their best health in an affordable, convenient, and comprehensive manner. Combining the assets of our health insurance products and services with CVS Health's unrivaled presence in local communities and their pharmacy benefits management capabilities, we're joining members on their path to better health and transforming the health care landscape in new and exciting ways every day.

• Leading the team that is accountable for leading and implementing Network strategy focused on optimizing local market network performance and cost, delivering strategic network goals. Ensuring all contracting efforts with hospital/provider systems deliver appropriate outcomes.
• Directing oversight of the provider network and responsible for managing the total cost of care for members and clients.
• Ownership of local market unit cost targets, medical cost strategies, risk adjustment and contract deviation; and collaboration with regional VBC teams responsible for negotiation and administration of VBC contracts.
• Accountability for efficient contracting efforts across all provider types securing favorable unit cost positioning. Ensuring alignment to core processes for contract administration, for example, accurate and timely contract loads.
• Providing 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.
• Cultivating strategies to improve the health care experience for members and for improving the experience of providers.
• 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.
• Overseeing and ensuring effective development and management of the provider network functions including 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.
• Responsibility 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.
• Setting 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.
• Managing their local market provider relations, utilizing support structure to drive improved provider experience resulting in favorable unit cost positioning and innovative reimbursement structures to drive favorable positioning.
• Managing medical costs in close partnership with Clinical Functions and drives change to improve cost structure partnership.
• Developing and maintaining strong relationships with the Market President, Market CFO, Chief Medicare Officer (CMO) and Segment Leads to ensure alignment in developing and executing strategies that drive profitable membership growth.
• Partnering with sales to develop and execute customer specific network solutions to retain and win critical plan sponsors.
• Representing Aetna to legislative, regulatory and community partners.
• Consulting with the Market Compliance Consultant on state network filings and support the work with resources aligned in the local markets.
• Active engagement in the development and assessment of internal policies impacting Providers and Network Operations.
• Supporting CVS Health in attracting, retaining, and engaging a diverse and inclusive consumer-centric workforce that delivers on our purpose and reflects the communities in which we work, live, and serve.

• 10+ years of healthcare network & contracting experience with a national health plan or large hospital system.
• Medical Economics experience valued.
• Proven people leadership skills.
• Strong understanding of fee for service and value-based contracting with medical and behavioral health systems and physician groups.
• Knowledge of industry segments including Commercial, ACA, Medicare, and Medicaid.
• Strong presentation and communication skills; ability to consult as well as negotiate contracts.
• Strong analytical skills including root cause analysis.
• Ability to think strategically.
• Skilled at collaborating and working across a complex matrixed organization.
• Expertise in market level management, cost drivers and levers, and knowledge of economic, regulatory and marketplace issues.
• Possess exceptional leadership skills and transformational experience with a proven track record of delivering results.
• Must be based in Florida or Georgia or willing to relocate.
• Demonstrate a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias.