Req ID: 54545BR
To dramatically improve its relationships with hospitals and physicians, Aetna established five JVs with leading hospital systems across the US. Its mission is to develop mutually beneficial partnerships that enable their transformation from a hospital factory to a clinically integrated supplier of high quality, cost-efficient healthcare, and create a step change in the member/patient experience. In the past 2 years this team launched JV health plans with Banner (Arizona), Texas Health Resources (Dallas/Fort Worth), Allina (Minneapolis/St. Paul), and Sutter Health (San Fran/Sacramento) all of which complement our flagship joint venture with Inova (Northern Virginia). We introduced Medicare products at Innovation Health, our JV with Innova, in 2018, and Allina Health | Aetna for 1/1/19.
The Senior Director, JV Medicare Strategy and Business Development:· Serves as the lead for Medicare product strategy and management across the JVs, working in close collaboration with the Medicare General Manager at each JV and with the Medicare Segment· Coordinates Aetna, JV and health system resources (including two direct reports) to successfully deliver complex projects and/or programs supporting the JV Medicare products· Provides oversight for product performance while working collaboratively with the JV and across the enterprise· When launching Medicare at a JV, drives bringing the right functional expertise to the table (e.g., Medicare Marketing, Medicare Stars) to support successful market entry Responsibilities · Conduct market analysis, including Hospital Market Share, Medicare eligible seniors and MA enrollment rates, competitor and product market share for both Individual and Group, and competitor plan comparison· Perform market research to identify market-specific needs · Understand and assess hospital system partner capabilities to develop differentiated product strategy · Develop JV-specific Medicare value proposition that is unique and difficult to replicate for competitors. Use value proposition to drive marketing and bid design· Construct membership model working with actuaries, MA segment, and respective Medicare GM to create a membership model for each JV and determine “fair share · Work with local market, Medicare segment, and actuaries to create a bid annually for filing with the federal government and participate in bid cycle as each new round of pricing and associated trade-offs becomes available· Identify services/vendors that will aid in competitive plan design, and work with Medicare Segment Contracts COE to negotiate contracts and ensure compliance with CMS regulations· Serve as JV MA lead in Aetna internal meetings, work with JV Engagement Managers on materials for JV Management, Joint Operating Committees, and Boards of Directors.· Annual Enrollment Period: Monitor sales daily, check trends weekly, contribute to marketing decisions, and conduct AEP post-mortem· Bring all materials, questions, issues to Compliance to ensure everything is in lock step with CMS regulations · Support partner functions as they develop and lead:o Design of marketing models (AEP, Lock-in, Provider), working with MA segment, JV Medicare GM, and Marketing (e.g., provider marketing, % leads supplied by brokers)o Development of annual Medicare technology and operations budget (e.g., Platform), o Development and implementation of member experience strategy, leveraging the partner/clinically-integrated network to create unique experienceso Development of network strategy for Medicareo Confirmation of scope and delivery of critical reports needed by Medicare GM and clinical teams to drive the businesso Creation of Stars strategy and execution roadmap· Understand/support delivery of Medicare-related services provided to the JV as part of the PMPM fee the JV pays to Aetna (i.e., the Rate Card) Qualifications DesiredPassion for transforming healthcare by breaking new ground and launching innovative Medicare solutions as an integrated health plan and hospital system Minimum 10 years of healthcare industry experience, including expertise in Medicare 5+ years healthcare strategy consulting experience, with related management and leadership experience Proven leadership experience setting strategic direction and influencing change that resulted in quantifiable business outcomes Demonstrated track record managing complex projects and or programs that delivered financial results Proven experience developing analyses, recommendations and roll-out approaches to successfully implement strategy or change initiatives.Experienced in driving complex initiatives through a highly matrixed environment, requiring the participation and support of multiple business functions 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 developing business cases Proficiency across Microsoft Office Suite Demonstrated relationship management skills at the senior levels within an organization and external constituents. Excellent verbal and written communication skills.Education· Bachelors required· MBA, MPH, or similar required, focus in healthcare or finance preferred Location: Role can be based in New York, NY; Hartford, CT; Wellesley, MA; Washington, DC; Minneapolis, MN, or Chicago, IL. Additional Information:Working on the JVs at Aetna is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare, working in partnership with leading providers. We are inspired to make a difference, and to empower people to live healthier lives. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
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Job Function: Product & Marketing
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.