Executive Director, Network Management - Keystone Territory

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate.

And we do it all with heart, each and every day.

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.

Aetna is recruiting for an Executive Director, Network Management who provides strategic leadership and oversight for network management and provider relations within the Keystone territory of Pennsylvania and West Virginia
. This leader will develop and implement network strategies, manage provider contracts and negotiations, monitor provider performance metrics, lead dispute resolution processes, and collaborate with key stakeholders to drive network growth and ensure high-quality provider relationships.

• Overseeing key network management contracting activities, including negotiating fee schedules, reimbursement rates, and contract terms and conditions.
• Controlling the development and expansion of the company's provider network by evaluating potential network providers, negotiating contracts, and establishing relationships with healthcare providers to ensure a comprehensive and high-quality network.
• Contributing to optimizing the network's performance and effectiveness by analyzing network data, utilization patterns, and market trends to identify opportunities for network enhancements, cost savings, and improved access to care.
• Managing the performance of network providers, including tracking key performance indicators, analyzing provider performance data, and implementing performance improvement initiatives.
• Conducting market analysis, assessing competitive landscapes, and making recommendations for network expansion strategies.
• Communicating findings to executive leadership and stakeholders, identifying opportunities for improvement and cost containment.
• Managing operational aspects of the team, subsequently implementing workforce and succession plans to meet business goals and objectives.
• Guiding management for individual performance evaluations aimed to provide critical feedback for skills development and depth of work area experience.

• 10+ years of experience in managed care; leading and managing teams.
• Experience contracting with providers and hospital systems within the territory.
• Comprehensive understanding of hospital and physician financial issues and how to leverage technology to achieve quality and cost improvements for both payers and providers.
• In-depth knowledge of various reimbursement structures and payment methodologies for both hospitals and physicians.
• Comprehensive understanding of value-based strategies and population health management, and Aetna's related strategic initiatives.
• Strong experience building and maintaining relationships with large hospitals/provider systems, integrated delivery systems and large physician groups.
• Understands the regulatory environment and ensures contractual compliance with federal and state requirements.
• 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.
• High ability to drive new strategies or initiatives in highly cross‑functional environments.
• Expertise with influencing and navigating a highly matrixed environment.
• Effe…