Aetna CA MCD Director, Network Management - 37949BR in Fresno, California

Req ID: 37949BR

California Medicaid, Director, Network Management

Position Summary:

Negotiates, competitive and complex contractual relationships with providers according to pre-determined internal guidelines and financial standards. Works cross-functionally to execute network strategies. Maintains accountability for specific medical cost initiatives. Manages local network management team.

Fundamental Components:

(*) Effectively negotiates complex, competitive contractual relationships with providers according to prescribed guidelines in support of national and regional network strategies

(*) Manages provider compensation/reimbursement and pricing development activities

(*) Responsible for understanding and managing medical cost issues and initiating appropriate action

(*) Provides sales and marketing support, community relations and guidance with comprehension of applicable federal and state regulations

(*) Assist and facilitate business intent reviews (BIR)

(*) Initiate legal reviews as needed; ensure all required reviews completed by appropriate functional areas

(*) Regional owner of Strategic Contact Manager (SCM) and rate wizard

(*) Act as a SME for PRL/Recruiters supporting ancillary and large physician group contracting

(*) May supervise day-to-day operations of network management teams/units

(*) Assist with the design, development, management, and/or implementation of strategic network configurations and Manages local Provider Relationship Management, Organization Orientation, Provider Advocacy


(*) Must possess a successful track record negotiating large hospital system contracts. Bachelor's degree. MBA/Masters degree preferred.


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


Benefits Management/Interacting with Medical Professionals/MASTERY

Sales/Managing Competitive Networks/MASTERY

Sales/Negotiating collaboratively/MASTERY


Leadership/Driving a Culture of Compliance/MASTERY

Leadership/Driving Strategic and Organizational Agility/ADVANCED

Technology/Leveraging Technology/MASTERY

Telework Specifications:

May be considered for telework; however must be local to California and be able to travel to provider offices routinely and as needed.


Ideal candidate will have a comprehensive understanding of hospital and physician financial issues and how to leverage technology to achieve quality and cost improvements for both payers and providers. In-depth knowledge of managed care business,regulatory/legal requirements, products, etc.

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.

Job Function: Health Care