Aetna Provider Network Manager in Woodland Hills, California
Req ID: 39029BR
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.
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 () Responsible for understanding and managing medical cost issues and initiating appropriate action () 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 () Exhibits the following Network Manager Behaviors
Must possess a successful track record negotiating large hospital system contracts.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Network Management/Contract negotiation/1-3 Years
Functional - Network Management/Provider relations/4-6 Years
Functional - Network Management/Credentialing/1-3 Years
Technical - Desktop Tools/Microsoft Outlook/7-10 Years/Power User
Technical - Desktop Tools/Microsoft PowerPoint/7-10 Years/Power User
Technical - Desktop Tools/Microsoft Word/7-10 Years/Power User
Technical - Desktop Tools/TE Microsoft Excel/7-10 Years/End User
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Leadership/Creating a World Class Workforce/FOUNDATION
Leadership/Driving a Culture of Compliance/ADVANCED
Finance/Servicing Customers Profitably/MASTERY
General Business/Turning Data into Information/ADVANCED
FT WAH position. Training may take place in the office as well depending on circumstances. Hiring manager to make decision regarding training schedule.
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.
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