Aetna Bus Proj Program Sr Mgr in Blue Bell, Pennsylvania

Req ID: 43926BR


Dynamic position on the NextGen Product/Network/Claim Enablement and Configuration team responsible for leading the full conversion, implementation, and maintenance of Aetna products, networks, and associated functions on the NextGen platform, specifically, Health Rules Payor (HRP). Lead the delivery of complex cross functional projects independently or through small work teams. Plan, prioritize, and be on point to resolve all issues and risks. Deliver work in compliance with all regulatory requirements, and in alignment with clinical/medical/claim policies. Lead the identification and solution the development of all business requirements, and lead/partner with IT and other business areas in the delivery of systems enhancements, business data configuration strategies, and workflow adjustments. Work is varied with opportunities to focus on multiple disciplines including product assessment, network composition and provider pricing, data migration/integration, etc.

Fundamental Components:

Success will require a self-starter, able to collaborate, influence and lead large projects/business processes across multiple disciplines, managing numerous priorities in a fast paced, changing environment. You will drive and make decisions based on strategy, compliance, and business requirements, engaging areas involved in the delivery including Network, Product, Claim, Legal/Compliance, Policy, IT, and external vendors. You will identify, define and support the delivery of business data configuration, systems integrations, workflow processes and regulatory requirements. You will prioritize the work and negotiate delivery. You will document and make recommendations on system enhancements required of our vendors. You will document issues/risks, decisions, requirement changes, and mitigating actions to keep work on track, and to influence reporting to Senior Management. You will be challenged to understand integrations and for ensuring the delivery supports the end to end goals of the program. You will support production by triaging and resolving issues impacting our ability to serve our providers and members. Strong communication skills and the ability to negotiate effective outcomes required.


Effective leadership; management of multiple, complex projects; prior experience in medical product development, network development or systems and/or claim a plus; Medicare background or Medicare project implementation or compliance a plus.


The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.


Functional - Project Management/Cross-functional project management/7-10 Years

Functional - Project Management/Project Leader/4-6 Years

Functional - Claims/Claim processing - Medical or Hospital- HMO/1-3 Years

Functional - Products-Medical/All Aetna Standard Plans/1-3 Years

Functional - Network Management/Provider connectivity/1-3 Years


Technical - Aetna Applications/Automated Claim Adjudication System/1-3 Years/

Technical - Aetna Applications/HMO Claims Processing System/1-3 Years/

Technical - Aetna Applications/Strategic Contracts Manager/1-3 Years/

Technical - Aetna Applications/Enterprise Provider Database System/1-3 Years/


General Business/Ensuring Project Discipline/MASTERY

Leadership/Creating Accountability/MASTERY

Leadership/Developing and Executing Strategy/MASTERY


General Business/Demonstrating Business and Industry Acumen/MASTERY

Leadership/Anticipating and Innovating/MASTERY

Leadership/Driving Change/MASTERY

Telework Specifications:

Flexible telework / office-based schedule (you can live near any office location)


We are looking for dynamic, energetic, self-starters to join our cross functional, multi-disciplined organization, supporting the core administrative functions of the NextGen platform. The environment is fast-paced, challenging and changing. This is an opportunity to develop both professionally and personally while supporting a challenging growth initiative for Aetna.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

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.

Job Function: Management