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The Lead Director, Provider Data Governance will develop, enhance, and refine the provider data strategy for Aetna's rapidly growing government programs segments. This position will be responsible for supporting strategic design and ensuring the end-to-end integrity and accuracy of provider data that is critical for seamless access to healthcare services for our government programs members. This role creates and maintains the provider data governance processes and rules to ensure all provider information is accurately recorded and maintained to provide for proper reimbursement and member access (e.g., directory listings). Aligns policies and procedures for the Provider Data Governance department with organizational goals.

• Collaborate with Network Contracting, Credentialing, Provider Data Services, IT, Digital, Claim Operations, and other cross functional teams to understand data requirements, workflows, and systems to ensure the accuracy of provider data throughout the entire lifecycle.
• Establish and enforce policies and procedures for the collection, maintenance, and dissemination of provider data, ensuring compliance with industry regulations and best practices.
• Develop and implement robust data quality standards and processes to maintain the accuracy and integrity of provider information.
• Develop and execute strategies for continuous improvement in data quality and accuracy, increasing automation and reducing manual workarounds.
• Work closely with internal stakeholders, including IT, Compliance, Network, Service Operations, Product, and Analytics & Behavior Change to align data governance practices with organizational goals and objectives.
• Identify and mitigate risks related to provider data accuracy, collaborating with Compliance to ensure adherence to regulatory requirements.
• Define key performance indicators (KPIs) for provider data governance and regularly report on effectiveness of data management initiatives.
• Utilize data-driven insights to drive improvements in provider data governance processes.
• Partner with cross-functional leaders as new products/strategies are brought to market, ensuring provider data elements are appropriately considered and developed.

• 10+ years managed care / network / health insurance industry experience, specifically in Medicaid.
• Demonstrated experience successfully driving change in complex organizations.
• Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously.
• Experience with enterprise-wide and/or cross-functional large-scale initiatives with high degree of complexity.
• Demonstrated leadership with relevant initiatives: Business process, enterprise business project management/consulting, and/or strategic planning.
• Strong quantitative skills with ability to structure, analyze, and interpret data to identify trends and draw logical conclusions; propensity toward supporting hypothesis with strong quantitative and qualitative evidence.
• Comfort with ambiguity, ability to create a process where one doesn't exist and deliver results

• Experience in large scale core platform migrations / integrations.
• Knowledge of QXNT.

• Bachelor's degree or equivalent professional work experience.