Connie Wiatrak
Aetna,A CVS Health Company
Seattle,WA
27
years of professional experience
Results-driven Senior Health Plan Executive with 20 years of experience in provider contracting, value-based arrangements, and network strategy. Expertise in driving commercial growth, optimizing costs, and managing P&L while leading cross-functional teams. Skilled in developing strategic partnerships and executing go-to-market strategies for employer and individual segments.
Work History
Lead Director
13 Years 7 Months- Manage development of Commercial and Medicare contracts and value-based agreements with providers and delivery systems in conjunction with being accountable for designing conceptual models, strategic alignment, operational success, performance management and negotiating high value/risk contracts with the most complex and challenging, market/region/national, largest groups/systems or highest value/volume of spend.
- Drive sustainable growth and market share while working collaboratively with providers and clinical/analytical teams to reduce medical cost trends.
- Drive or guide development of holistic solutions or strategic plans to negotiate and execute contracts with the most complex, market /region/national, largest groups/systems or highest value/volume of spend providers with significant financial implications.
- Collaborate with Sales to retain and/or win new business, including responses to RFPs.
- Implement value-based products/programs
- Negotiate and execute, conduct high level review and contract financial analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market-based, group/system providers. Manage contract performance and supports development and implementation of value-based contract relationships in support of business strategies.
- Identify and recruit providers to achieve network expansion and adequacy targets. Accountable for cost arrangements within defined groups.
- Collaborate cross-functionally with finance, underwriting, actuary, sales, clinical, and operations to manage provider compensation and pricing development activities, submission of contractual information, and review analysis of reports as part of negotiation and reimbursement modeling activities.
- Collaborated cross-functionally to identify and manage cost issues, executing significant cost-saving initiatives. Designed, developed, managed, and implemented strategic network configurations and integration activities.
- Led efforts to create holistic strategies for negotiating complex contracts with providers. development of holistic solutions or strategic plans to negotiate and execute contracts with the most complex, market /region/national, largest groups/systems or highest value/volume of spend providers with significant financial implications.
- Evaluate, help formulate, and implement provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.
- Cultivated strong partnerships with key provider partners to enhance operational effectiveness. with key provider partners. Ensure engagement from both parties (operational, contractual, clinical, population health teams) for a successful relationship.
- Collaborate with internal partners to assess effectiveness of tactical plan in managing costs. Optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.
- Collaborate with providers on integrating value-based contracting as revenue vs. straight fee-for-service increases.
- Set specific, challenging and achievable contracting objectives and action plans for the Network team.
- Ensure resolution of escalated issues related to contract interpretation and parameters. Interpret contractual requirements including federal and state regulations and NCQA. Participate in JOC meetings.
- Partner with compliance/legal/regulatory teams to ensure networks and contracts meet regulatory requirements. Work with Compliance on issues in AK, OR, WA and ID.
- Set specific, challenging and achievable contracting objectives and action plans for the Network team, continuing to drive Aetna expand network in Alaska, Oregon and Washington while driving the company to best discount position in the market.
- Using inclusive leadership practices, manage, mentor and coach new/more junior staff (other Lead Directors, Senior Network Managers and Contract Negotiators). Mentor team members to enhance their professional development, resulting in higher employee retention rates. Foster positive company culture through open communication channels and employee recognition programs. Set and monitor performance goals for team members, providing constructive feedback and support to drive their professional growth.
Senior Network Manager
9 Years 9 Months- Negotiated and executed high-level contract reviews and rate analyses, resolving disputes and settling negotiations with complex regional hospital systems, large physician groups, and ancillaries.
- Managed contract performance and implemented strategic, value-based contract relationships while enhancing provider networks to achieve accessibility, quality, and financial goals.
- Recruited providers to ensure attainment of network expansion and adequacy targets.
- Collaborated cross-functionally to manage hospital, ancillary and provider compensation and pricing development activities, submission of contractual information, and review and analysis of reports as part of negotiation and reimbursement modeling activities
- Optimized interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met. Participated in JOC meetings.
- Negotiated, executed, and conducted high-level review and rate analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, regional-based hospital systems, large physician groups, and ancillaries.
- Identified and managed cost issues and initiated appropriate cost saving initiatives and/or settlement activities.
- Collaborated cross-functionally to manage hospital, ancillary, and provider compensation development, ensuring timely submission of contractual information and thorough review of reports for negotiation and reimbursement modeling.
- Represented company with high visibility constituents, including customers and community groups. Promoted collaboration with internal partners.
- Provided network development, maintenance, and refinement activities and strategies in support of cross market network management unit.
- Assisted with design, development, management, and or implementation of strategic network configurations and integration activities.
- Served as SME for less experienced team members and internal partners.
Network Account Manager
3 Years 2 Months- Supported service and administration of Aetna’s products, developing strong provider relationships and executing workflows to effectively meet customer and Plan Sponsor needs, driving profitable growth.
- Conducted quarterly meetings with providers to discuss service levels, share process improvements, identify gaps, determine root causes, and develop tailored solutions.
- Addressed customer requests for claim analysis and benefit clarifications, ensuring accurate and timely responses.
- Successfully resolved escalated issues, preventing potential loss of valuable clients while maintaining positive relationships with all parties involved.
- Promoted use of Aetna's provider website and led trainings in provider offices.
- Responded to customers’ requests for claim analysis and benefit questions and clarifications.
Education
Bachelor of Arts - Management
MBA - Business Management
Skills
Strategic Partnerships and Alliances
Commercial Line of Business Strategy
P&L and Financial Performance Management
Sales & Account Management Partnership
Network Development
Go-to-Market (GTM)Strategy & Execution
Product & Benefit Design (Value-Based / Integrated Care)
Matrixed Cross-Functional Leadership
Regulatory Compliance & Risk Management
Skills
- Conflict Resolution
- Coaching, Mentoring, and Team Development
Timeline
Lead Director
Aetna,A CVS Health Company
01.2013 - CurrentRead More
Senior Network Manager
Aetna, A CVS Health Company
04.2003 - 01.2013Read More
Network Account Manager
Aetna, A CVS Health
02.2000 - 04.2003Read More
Seattle University
Bachelor of Arts from Management
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Seattle Pacific University
MBA from Business Management
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