POSITION SUMMARY Director of Provider Experience has functional responsibility for all contracting efforts, provider relations, and plan operations. Provider strategy and leadership to ensure plan effectively contracts at reasonable rates, drive provider satisfaction, and improve internal operational efficiency.
Fundamental Components:
- Develop and execute a network strategy intended to provide robust access to care for Aetna Better Health of Louisiana members.
- Effectively negotiate complex provider contracts with the aim of driving quality and reducing the total cost of care.
- Lead all provider relations efforts to educate providers, enhance access, ensure accurate provider data, and drive quality outcomes by working with providers to reduce gaps in care.
- Lead plan operational efforts to ensure accurate configuration of provider data and prompt and accurate claims payments.
- Provide leadership to Contracting, Provider Relations, and operational teams.
- Work closely with the Quality, Populations health and value-based Solutions team to drive quality within the health plan for members.
BACKGROUND/EXPERIENCE desired:
- Must possess a successful track record negotiating large hospital system contracts.
- Must have Managed Care operational experience with a basic understanding of claims processes, configuration, and contract pricing.
- Strong plan operations and contracting experience is required.
- A strategic mindset is required.
- Medicaid preferred.
EDUCATION The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Customer Service/ is desired
Business/ is desired
FUNCTIONAL EXPERIENCES
Functional - Management/Management - Network Management/4-6 Years
Functional - Management/Management - Operations/4-6 Years
Functional - Claims/Management: Functional - Management/Management - Provider Data/4-6 Years
Functional - Network Management/Network market leadership/4-6 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft PowerPoint/4-6 Years/End User
Technical - Operating Systems/Windows/4-6 Years/
REQUIRED SKILLS General Business/Demonstrating Business and Industry Acumen/ADVANCED
Leadership/Creating Accountability/ADVANCED
Leadership/Driving a Culture of Compliance/MASTERY
DESIRED SKILLS Leadership/Engaging and Developing People/ADVANCED
Service/Creating a Differentiated Service Experience/ADVANCED
ADDITIONAL JOB INFORMATION
Great opportunity to work with a growing team to drive quality and strong provider relations within a growing market. Aetna Better Health of Louisiana is a strong performing plan with an excellent leadership team.
Aetna is about more than just doing a job. This 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. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click to review the benefits associated with this position.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
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Employment Type Regular
Career Band Description Management
