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.

POSITION SUMMARY

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.

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 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

BACKGROUND/EXPERIENCE desired:

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.

EDUCATION

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

FUNCTIONAL EXPERIENCES

Functional - Network Management/Contract negotiation/4-6 Years

Functional - Network Management/Network market leadership/1-3 Years

REQUIRED SKILLS

Leadership/Developing and Executing Strategy/ADVANCED

Sales/Negotiating collaboratively/MASTERY

Service/Demonstrating Service Discipline/ADVANCED

DESIRED SKILLS

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