Top leadership position providing strategic direction and leadership to Texas Health
+ Aetna joint venture to achieve market goals. Provide oversight of the Texas Health
Aetna joint venture leadership team(s); includes, but not limited to, ensuring
alignment with Aetna and Texas Health Resources vision and values; collaborating
across both owner organizations. Ensure successful development of Texas Health
+ Aetna provider network, including building strategic value-based relationship with
University of Texas Southwestern Medical Center UTSW and THR, and other
Provide oversight of the Texas Health Aetna joint venture leadership team(s);
includes, but not limited to, ensuring alignment with Aetna and Texas Health
Resources vision and values; collaborating across both owner organizations.
• Developing the company strategy to address both short-term and long-term
market potential and business opportunities
• Communicate the company’s transformational market vision and strategy in bold
and persuasive terms and gain buy-in within the organization and build support
• Constructively challenge the conventional wisdom of accepted ways of doing
things and will deeply understand the marketplace and the competitive
• Continuous innovation of company value proposition in order to maintain
differentiated leadership position.
• Sets, communicates, and executes operational strategy and performance
measures in line with company, segment, region, joint venture and market goals
• Analyzes competitive environment to support and improve pricing, underwriting,
and product development strategies as well as sales and service efforts for Texas
Health Joint Venture. Cultivates and maintains strong relationships with all
constituents (producers, plan sponsors, providers, customers, and regulatory
• Maintains accountability for specific medical cost initiatives to achieve target
medical/Rx trend results with focus on network price/synergies, scoreable actions
and medical cost management initiatives.
• Partner with local sales, account management, and network teams; responsible
for driving new distribution strategies and rigorous financial management.
• Building and growing the company within current and targeted expansion
geographies leveraging company and owner assets to rapidly scale business and
deliver on financial goals.
• Builds strong collaboration and demonstrate effective influencing skills with
critical matrix partners across Underwriting, Actuary, Finance, Product,
HCM/Clinical, Compliance, Human Resources, Marketing, Medical Economic
Unit and Service.
• Conducting financial analysis, forecasting, revenue modeling, and valuation of
the company at various developmental stages.
• Initiates legal reviews as needed; ensures all required reviews are completed by
appropriate functional areas. Drives compliance in all market business.
• Serving as the organization’s representative and will leverage company’s
transformational vision and capabilities to influence a wide array of professional,
policy and regulatory circles.
• Provides comprehensive understanding of hospital and physician financial issues
and how to leverage technology to achieve quality and cost improvements for
both payers and providers. Provides oversight of network and geographic
strategies across continuum from traditional fee-for-service to value-based
contracting including Accountable Care Organizations for all business segments.
• Responsible for the oversight of negotiations including competitive and complex
contractual relationships with providers according to pre-determined internal
guidelines and financial standards
- •10+ years of general management, sales and/or network management experience
In-depth knowledge of managed care business, regulatory /legal requirements,
products, programs, strategy and objectives.
• Expertise in Health Insurance, Population Health, including analytics, care
management, payer/provider network contracting and management and risk
management, especially involving value-based care relationships.
• Experience in working with ACOs, Patient-centered Medical Homes and Patient
Centered Specialty Practices.
• Visionary, creative, and able to see solutions where others do not as well as able
to lead and rapidly implement transformative change.
• Highly effective communicator, with demonstrated ability to influence c-level
executives and a track record of negotiating win-win solutions.
• Familiar with Medicare Advantage programs and products, and will come with a
strong understanding of utilization management, care coordination, and case
• Strong awareness of mid and large employers purchasing preferences and
processes, and will able to proactively anticipate the needs from this segment.
• Experience leading in a high-growth, start-up environment