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Role Overview:The AVP of Provider Performance and their team will be accountable for driving financial and operational performance of Aetna’s network providers. Primary Job Duties & Responsibilities:

• Ensure that assigned arrangements are functioning successfully and working to improve quality of care while reducing costs.

• Work collaboratively with provider to meet their evolving needs and to improve the health outcomes of their patients

• Partners with Chief Network Officer, Line of Business Leaders, Quality, Clinical and Revenue Integrity leaders to set annual strategy and deliver against provider performance goals

• Coach provider performance team to execute on the strategy and ensure performance plans by provider are created with key KPI’s developed.

• Deploy provider performance team based on tiered engagement level of provider practice

• Deploy Provider Performance team to engage with multiple provider types (National, large MSO, small primary care etc.)

• Ensure team develops a deep understanding of financial drivers of success for government programs (Medicare, Medicaid and Commercial Exchange) that includes quality, documentation and engagement.

• Scale and deploy education programs to providers to drive successful deployment of provider behavior change initiatives

• Develop requirements and SLAs with analytics and technology teams to develop best in class reporting and point of care tools to support provider engagement.

• Leverages reporting/data to monitor contract performance against financial, clinical, cost and efficiency targets and translates data into actionable insights

• Perform and interpret complex financial assessments and contracts.

• Provide strategy consultation on actions/tactics to make improvements in practice performance

• Ensure performance team is tracking, managing and meeting practice goals and objectives.

• Provide updates on performance to both internal and external executive leaders thru Joint Operating Committees and Executive meetings.

• Understand enterprise-level quality and documentation initiatives and ensure deployment with physician practices (record retrieval, etc.)

• Work collaboratively with Network team on re-contracting strategies and provider viability.

Qualifications:

• Approximately 15+ years experience in a provider organization or health plan

• Knowledge of Medicare and Medicaid will be highly valued

• Strong understanding of Medicare Stars, Risk Adjustment and cost of care levers.

• Knowledge of primary care office workflow will be highly valued

• Mastery of/direct experience with Provider Contracting, Plan Design and Product Offerings

• Experience with provider contracting and negotiations

• Expertise in market level management, cost drivers and levers, and knowledge of economic, regulatory and marketplace issues

• Proven ability to interact with, influence and collaborate with internal and external stakeholders at all levels

• Experience in a matrixed environment

• Proven track record managing complex projects and or programs that resulted in cost savings

• Strong executive presentation skills

• Management experience managing large, dispersed, highly skilled professional teams

• Ability to work hybrid in an Aetna hub

Education:Bachelor's degree or equivalent

Pay Range

The typical pay range for this role is:

$157,800.00 - $363,900.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 07/17/2024

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.