Aetna Network Account Manager in Blue Bell, Pennsylvania
Req ID: 45552BR
Develops strong relationships with network providers and interval business partners leading to the achievement of provider satisfaction, medical cost targets, network growth and/or efficiency targets. .
Communicates with external constituents to effectively engage the provider community and demonstrate the Aetna
Negotiate contracts and other understandings on behalf of the company.
Manages medical cost drivers and executes specific medical cost initiatives to support financial and medical cost
Proactively identifies new trends and products within Aetna and the industry and works to raise awareness throughout
the organization in order to gain consensus on a course of action and ultimately drive to implementation.
Consistently monitors Aetna service capabilities to collaboratively ensure that provider constituents needs are met.
Seeks to optimize provider interaction and provides recommendations based on balance of provider needs and
Responsible for developing and maintaining relationships with facilities, physicians, and business leadership of key Health systems, physician groups, ancillary providers, and delivery systems.
Interacts with large, high profile Health Systems, physician groups, IPAs, PHOs to facilitate solutions that are
mutually beneficial for both providers and the organization.
Collaborates cross-functionally on more complex issues to ensure provider needs are met and outstanding issues are
resolved. i.e. provider service efficiencies, provider service improvement initiatives, identifies opportunities for process
Collaborates with internal team members on the implementation of large, high profile physician groups, IPAs, PHOs
and hospital systems to ensure a positive business relationship.
Proven ability to synthesize and translate competitive intelligence into decision-making process.
2-5 years industry experience. (Medical Cost Drivers and Managed Care Industry)
Working knowledge of provider business operations (PRL)
Analytical/data driven decision-making skills
Strong analytical and written/oral communication skills.
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
Functional - Claims/Claim processing - Medical or Hospital - ACAS/1-3 Years
Functional - Network Management/Provider relations/1-3 Years
Technical - Network/Provider contract management/1-3 Years/End User
Technical - Mainframe Tools and Software/HCD Base//
Service/Improving constituent-focused Processes/FOUNDATION
ADDITIONAL JOB INFORMATION
Opportunity to work with large Health systems and Physicians groups to improve member experience
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: Health Care