Jobs at Aetna – Southeast Regional Duals Officer

Job Description:

The National Duals Segment supports duals growth, expansion, strategy, clinical and administrative operations, and overall performance of all dual products. This position is focused on supporting overall market performance and growth by collaborating with key enterprise, market, and segment leadership to support dual products within a specified geographical region (Southeast Region includes AL, AR, FL, GA, LA, MS, NC, SC and TN). This position will be responsible for working with enterprise, market, segment departments and functions that support Aetna’s dual products, this position will serve as liaison focused on monitoring effectiveness and impact of state strategy, sales, product competitiveness, network, and overall product P & L performance within the specified territory. This position will have significant interaction with market DSNP Program Managers, assisting and coaching to ensure success.

Job Responsibilities:

• Drive growth and member experience as well as overseeing P&L performance for dual products
• Serve as liaison + SME supporting duals growth and expansion
• Collaborate with segment and product team leadership on DSNP benefit and bid strategy
• Strong collaboration with Chief Medicare Officers and Aetna Medicaid leadership in assigned markets to drive shared opportunities
• Partner with DSNP Program Managers to drive success, nurture state relationships/local partnerships and assure SMAC compliance
• Contribute to segment strategic planning and development of annual operating plan for Dual markets
• Identify financial opportunities for revenue enhancement, membership growth, medical cost savings, quality improvement, and administrative cost efficiencies
• Partner with markets to drive duals local product strategy and local market intelligence, partnering to achieve target market position
• Achieve market performance goals via local execution of STARs/quality withhold, compliance, and cost structure reduction (SAIs) initiatives in collaboration with Medicare market leadership, Dual’s segment leadership and related operational teams
• Work with marketing and sales, network, member retention, operations, and related operational areas to identify improvement opportunities focused on improving financial outcomes and member and provider engagement and satisfaction
• As applicable, serve as lead and SME collaborating with enterprise teams on expansions or new products in the assigned territory including integrated products such as FIDE SNPs, MMPs, and HIDE SNPs. Develop a comprehensive implementation plan for such products in collaboration with markets
• Develop and participate in presentations and consultations to internal and external audiences
• Monitor performance and outcomes of new and established programs and services

Job Requirements:

• 10+ years leadership
• Must have Medicare and DSNP experience including state strategy, marketing and sales, product development, and member retention
• Must have P&L expertise and possess a strong financial, bottom-line focus
• Strong facilitative leadership and business problem solving skills
• Effective technical skills regarding health plan administration, profit and loss accountability, medical management, business development, member engagement, quality outcomes, contract compliance, provider satisfaction, value-based contracting, local marketing/community outreach.
• Resides in and has knowledge of current DSNP marketplace dynamics in Southeast Region (AL, AR, FL, GA, LA, MS, NC, SC, TN)
• Ability to build relationships with a diverse workforce and cross functional groups
• Proven ability to work successfully within a matrix environment and influence internal stakeholders.
• Align with the Heart at Work Behaviors of CVS Health
• Put people first; Join forces; Inspire Trust; Rise to the Challenge; Create Simplicity
• Experience with Medicaid managed care including managed long-term care services and supports preferred
• Bachelors in a related field

Job Details:

Company: Aetna

Vacancy Type:  Full Time

Job Location: Tallahassee, FL, US

Application Deadline: N/A

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