Description: The NY DSNP Program Lead reports to the Chief Medicare Officer, NY/NJ and is accountable for overall performance of the NY DSNP product including growth and retention, network strategy and marketability, clinical outcomes, quality and financial performance. He/she develops and maintains effective relationships with appropriate state agencies, partners and community resources and is responsible for overall compliance with federal and state requirements. This is a highly collaborative role requiring ability to work effectively cross-functionally to drive results.
Accountable for leveraging local and corporate market and Medicare assets and overall company resources to implement and optimize the NY DSNP program and achieve strategic, operational and financial objectives of the program. Works closely with market-based teams and corporate teams to ensure effective and efficient initiative management and results. Become a trusted advisor and key resource for NY/NJ Medicare DSNP related issues for Medicare corporate teams and local markets.
Typically manages multiple managers and their work teams and/or most complex projects through to implementation. Sets strategic direction for team and/or complex projects and or programs (e.g., national in scope which may impact one or all segments, and typically runs multiple years in duration with high financial implications). Has full accountability for all aspects of projects and or programs such as financial, regulatory, marketing, etc. Fundamental Components:
- Leads and ensures that the organization develops and executes plans to successfully launch a DSNP program for 2021.
- Primary liaison and manages state relationship of DSNP officials and understands and interprets all requirements to corporate and local teams to ensure compliance and effective processes
- Builds relationships with key community resources (Area Offices on Aging, SHIP, etc.)
- Works with Marketing and Sales team to develop marketing and sales strategies and execution and to ensure all materials are customized effectively to support the NY DSNP program; ensures compliance with all state guidelines
- Serves as liaison with local Aetna Medicaid business team to develop and support cross-selling activities
- Leads activities to ensure that data sharing requirements with the state are established and work effectively
- Participates in DSNP network design, provider reimbursement and education strategies and programs and presents/meets with key provider partners to support the programs success
- Works with STARs lead and local Quality Lead to ensure that the DSNP program is exceeding quality standards and contributing positively to STARs outcomes
- Works with Sales Director and Member Retention lead to establish sales and member retention strategies to drive growth and optimize retention
- Works closely with local and national clinical professionals to design programs and outreach to ensure members are receiving the highest quality of care and support
- Works with the Chief Medicare Officer, product team and actuaries to develop and submit an accurate and competitive CMS bid
- Proactively leads DSNP program and/or most complex projects by setting strategic direction and leading execution
- Develops executive level and external presentation materials as needed
- Organizes, leads and facilitates discussions to engage key players required to help local markets develop and execute an optimal DSNP strategy
- Works collaboratively with health plans, territories, and business segments on Medicare network related activities such as service area expansions, adequacy, compliance, audits
- Communicates in a candid, transparent and persuasive manner, seeking others input and adjusting approach based on audience and the need
- Leads NY Medicare DSNP work team meetings and ensures effective follow up and closure on work items
Sets the direction of the strategic business plan and translates into vision for staff/others As a business leader, influences all stake holders to support key projects/programs to ensure positive outcomes that deliver on results. Drives change in order to improve performance results, organization effectiveness and/or systems/quality/services (e.g., policies, processes or systems). Identifies gaps in processes or organization and challenges self and others to develop and implement solutions. Directs accountability for impact to SG&A - Ensures accurate prioritization of key projects/programs within purview. Has ultimate accountability for project management services being delivered including organizations budget and/or financial implications. Typically manages staff.
#LI-HH1 Background Experience:
- 10+ years experience and technical/functional expertise, with advanced knowledge in one or more of the following at a managed care or provider organization:
- DSNP programs
- Managed Care Operations
- Medicare Advantage
- Proven track record of driving cross-functional results meeting project milestones
- Demonstrated relationship management skills at a senior level and with external constituents
- Strong background in DSNP program and Medicare
- Skilled and experienced at leading cross-functional work and teams
Education and Certification Requirements:
- Bachelors degree required
- Masters degree is a plus
- Project Management certification and/or process improvement certification is a plus
Demonstrated negotiation skills. Proven track record managing complex projects and or programs that resulted in cost savings. Multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes. Experience managing large budgets. 10+ years managed care / health insurance industry experience. Project management experience. Supervisory experience. Bachelor's degree or equivalent experience. Additional Job Information: Ability to communicate effectively with management. Potential Telework Position: Yes Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Candidate Privacy Information: 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.