Aetna Dir, Network Management in Sunrise, Florida
Req ID: 42827BR
Negotiates, competitive and complex Medicaid, MLTSS and CHIP contractual relationships to include (participation and Value-based agreements) with large health systems and large physicians groups to be able to meet strategy- Works cross-functionally to execute network strategies with a sense of urgency to deliver results- Maintains accountability for specific medical cost initiatives- Manages and supports the Florida local network team.
Please note: This position is office based in Sunrise, FL with the opportunity for some work from home option, but must live in proximity to the Sunrise office. Prior negotiation /network management experience is required.
Position will be responsible for strategic provider relationships which include maintaining and negotiating some of the most complex healthcare contracts in Florida. - Position will have focus on growing the network and introducing value based agreements with ACOs and other provider entities. - Manages other personnel to maintain a wide geographical area. - Manages and sets strategy for provider compensation/reimbursement and pricing development activities. - Manages medical cost issues and how to develop and execute action plans. -Negotiates contract language and initiates legal reviews as needed; ensure all required reviews completed by appropriate functional area. -Facilitates resolution of complex provider contracting issues.
Must possess a successful track record negotiating large hospital system contracts-desired experience in Medicaid.
Bachelor's Degree required. MBA/Masters degree preferred.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Network Management/Network market leadership/7-10 Years
Functional - Network Management/Contract negotiation/7-10 Years
Functional - Management/Management - Network Management/7-10 Years
Technical - Desktop Tools/Microsoft Word/7-10 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/7-10 Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/7-10 Years/End User
Engaging and Developing People
Managing Competitive Networks
Driving a Culture of Compliance
Driving Strategic and Organizational Agility
Medicaid position #3750
ADDITIONAL JOB INFORMATION
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 Medicaid managed care business, regulatory/legal requirements, products, etc. Proficiency with Microsoft Office Suite applications. Must possess exceptional organizational skills and communication skills (verbal, written and presentation).
Telework Specifications: May be considered for telework; however must be local and be able to travel to Office.
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