Aetna CA MCD Manager, Network Management - 37950BR in San Francisco, California

Req ID: 37950BR

California Medicaid, Manager, Network Management

Position Summary:

Design, develop, contract, maintain and enhance relationships with facilities, physicians and ancillary providers which serve as contractual networks of care for members; foster growth of managed care products; and enhance profitability of Aetna Medicaid. 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. Offices anticipated in San Diego and Sacramento.

Fundamental Components:

(*) Partner with health plan to determine network and contract needs.

(*) 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 in partnership with health plan management.

(*) Responsible for reporting, understanding and managing medical cost issues and initiating appropriate action in partnership with health plan.

(*) 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.

BACKGROUND/EXPERIENCE desired:

(*) Must possess a successful track record negotiating large hospital system contracts.

(*) Bachelor's degree.

(*) Masters degree preferred, MBA highly desired.

(*) Proficiency with MS Office Suite and applications including Word, Excel, etc.

EDUCATION

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

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/MASTERY

Sales/Managing Competitive Networks/MASTERY

Sales/Negotiating collaboratively/MASTERY

DESIRED SKILLS

Leadership/Engaging and Developing People/ADVANCED

Leadership/Fostering a Global Perspective/ADVANCED

Technology/Selecting and Applying Technology Solutions/ADVANCED

Telework Specifications:

Will be evaluated based on candidates location, candidate must reside in California and have a strong knowledge of the California market.

ADDITIONAL JOB INFORMATION

Our 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.

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