jennifer butler

Managed the production and analysis of medical cost information used to formulate effective network contracting and management strategies. Provided financial analysis and reporting of medical cost and utilization to executive and regional management.

Supported Northeast Region strategic and tactical initiatives. Ensured Regional priorities achieved/exceeded Operating Plan goals. Support Regional compliance initiatives to reduce internal and external exposure. Developed Regional communications. Drove commercial risk score improvement through various programs and initiatives.

Created professional contracting metrics tool to monitor long-term market strategies. Participated in annual Medical Cost Analytics operational planning process with responsibility for the National Medical Economics Unit monthly updates to the annual Operating Plan. Identified professional medical cost drivers and variances and communicate to regional and local market leadership. Created monthly drill-down reports of professional costs and develop strategies to mitigate them on both a national and regional level. Responsible for providing estimated unit cost impacts of CMS fee schedule updates to regional and local market leadership. Responsible for managing unit cost trend model for state and CMS fee schedules.

Responsibilities at Aetna Medicaid included coordinating the Network Operations three-year strategic planning process, with responsibility for the development of the Network Build timeline and Staffing Model for market expansions, as well as the annual Network Operations Operating Plan. Also, prepared and participated in Network Operations' Monthly Operating Reviews (MORs) and Quarterly Business Reviews (QBRs). Managed $1.6 million Consulting Budget and had responsibility for analyzing and presenting Operating Budget variances on a monthly basis to senior management. Led cross-functional Provider Contract Management Work Group to create contracting diligence and oversight for the Segment. Also assumed responsibility for coordinating and overseeing the segment-wide monthly Medical Cost Management meetings with representatives from local Plans (CEOs, COOs, and CFOs), Medical Management, Network, Finance, Actuarial, and Medical Economics.

Managed team responsible for providing medical cost analysis to assess the effectiveness of unit cost plans, identify variances to the plan, and provide strategies to offset unfavorable variances. Also responsible for the development of medical cost plans and trends in collaboration with Finance and Actuarial. Also Managed teams responsible for the financial analysis and unit cost pricing of 80,000+ PCPs and Specialists in the Region and 400+ hospitals. Responsibilities also included the development of a consistent hospital pricing model, DRG contracting standards, and a hospital pricing “toolkit”.

Responsible for responding to financial aspects of new business Requests for Proposals for National Account prospects (3000 + lives) and providing managed care pricing and risk management support. Duties included analyzing overall case risk, historical claim activity, and demographic information to determine appropriate claim levels, and competitively pricing benefit plans to meet profit, persistency, and sales goals. Developed effective working relationships with internal and external customers to accomplish sales and growth goals.

Provided project management support for Medicaid network initiatives. Also responsible for developing Medicaid-specific contracting policies and managing the Provider Contract Exception Process. Provided leadership support by collaborating with local Network Management and Medicaid analytics team to identify and implement network optimization initiatives, managing the weekly and monthly report submissions for the team, and preparing various strategy and planning presentations.

Provided expert advice and analytic support to executive management on NY Commercial cost of care issues and opportunities. Prepared healthcare cost analysis to identify trend drivers and new, innovative strategies to control costs. Prepared and presented monthly cost of care drivers to cross-functional leadership team.

Support network integration efforts for Humana integration