Aetna Director, Network Management (Team Negotiates Contracts, Manages Value-Based Agreements) in Sugar Land, Texas
Req ID: 42545BR
This position will sit in the Sugar Land, TX office location.
*This is not an IT Technology position.
P&L responsibility for Provider Network for South Texas. Manages local network management team. Negotiates, competitive and complex contractual relationships, including value based agreements, with providers according to pre-determined internal guidelines and financial standards. Manages medical cost trend and identifies and implements medical cost initiatives. Manages ACO/integrated delivery provider model products. Works cross-functionally to execute network strategies. Maintains accountability for specific medical cost initiatives. Supports activities to increase Aetna membership.
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 guidelines and activities
Manage value based agreements including ACOs and HPNs and work closely with providers to improve health of membership and to manage medical cost trend
Responsible for understanding and managing medical cost issues and initiating appropriate actions
Provides sales and marketing support, community relations and guidance with comprehension of applicable federal and state regulations
Initiate legal reviews as needed; ensure all required reviews completed by appropriate functional areas
Supervise day-to-day operations of network management teams/units (*)
Design, develop, manage and implement strategic network configurations
Manage local provider relationships
Must possess a successful track record negotiating complex hospital, integrated delivery system and value based agreements; managing medical costs and identifying trends and implementing strategies to mitigate trends; managing multiple, large, diverse provider networks; managing multiple layers of staff. Must have a bachelor's degree.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Network Management/Contract negotiation/4-6 Years
Functional - Network Management/Network market leadership/1-3 Years
Leadership/Developing and Executing Strategy/ADVANCED
Service/Demonstrating Service Discipline/ADVANCED
Finance/Delivering Profit and Performance/ADVANCED
Leadership/Creating a World Class Workforce/ADVANCED
ADDITIONAL JOB INFORMATION
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