Aetna Contract Negotiator in Wheeling, West Virginia
Req ID: 43949BR
Negotiates, re-negotiates and executes physician and/or provider contracts in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals. Position will have a special focus on hospital-based providers, physician groups, and ancillary providers including but not limited to ambulatory surgery centers and skilled nursing facilities.
This position supports the West Virginia market and will require some travel to that area.
Accountable for all aspects of physician and ambulatory surgery center recruitment and contracting as well as ad/hoc network contracting, as assigned. Responsible for re-negotiating or negotiating solo, complex group, hospital-based and large entity physician contracts in support of network quality, availability and financial goals. Participates in the strategic recruitment of physicians and ambulatory surgery centers satisfying specific network goals and objectives. Provides network development, maintenance and refinement activities and strategies in support of cross-market network management units. Partners across the organization to garner support for network contracting activities to ensure all aspects of operational implementation are completed on a timely and accurate basis.
Mastery of provider and facility contracts, contracting options, PADU guidelines as well as provider configurations. Communication Skills - Strong written and verbal communication skills. In-depth knowledge of the managed care industry and practices, as well as a strong understanding of Aetna competitor strategies. Solid negotiating and decision-making skills.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Network Management/Contract negotiation/3-5 Years
Functional - Network Management/Provider relations/3-5 Years
Functional - Network Management/Network market leadership/1-3 Years
Technical - Aetna Applications/Strategic Contracts Manager/1-3 Years/End User
Technical - Aetna Applications/Enterprise Provider Database System/1-3 Years/Power User
Benefits Management/Interacting with Medical Professionals/ADVANCED
Sales/Managing Competitive Networks/ADVANCED
General Business/Demonstrating Business and Industry Acumen/ADVANCED
General Business/Turning Data into Information/ADVANCED
Technology/Selecting and Applying Technology Solutions/FOUNDATION
Full-Time Telework (WAH); training period in the office may be required
ADDITIONAL JOB INFORMATION
Maintains strong working relationships with internal constituents within the following areas: Medical Economics Units, Contracts Coordination Unit, Provider Data Services, Sales, Patient Management, Legal and other areas within Aetna that are key to successful execution.
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