Aetna Network Manager - 52674BR in Dallas, Texas

Req ID: 52674BR

POSITION SUMMARY

Negotiates, executes, conducts high level review and analysis, dispute resoltution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.

Fundamental Components:

Negotiates and executes, conducts high level review and analysis, dispute resoltution and/or settelement negotiations of contracts with larger and more complex, market-based, group/system providers. Manages contract performance and supports the development and implementation of value based contract relationships in support of business strategies. Recruits providers as needed to ensure attainment of network expansion and adequacy targets.

Accountable for cost arrangements within defined groups. Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.

Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activities.

Serves as SME for less experienced team members and internal partners.

Provides network development, maintenance, and refinement activities and strategies in support of cross-market network management unit. Assists with the design, development, management, and or implementation of strategic network configurations and integration activities.

May optimize interaction with assigned providers and internal business partners to manage relationships to ensure provider needs are met. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.

BACKGROUND/EXPERIENCE desired:

Strong communication, critical thinking, problem resolution and interpersonal skills.

5-7 years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with individual or complex provider systems or groups.

Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.

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/Physician recruiting - medical/4-6 Years

Functional - Network Management/Provider relations/4-6 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools//1-3 Years/End User

REQUIRED SKILLS

Leadership/Developing and Executing Strategy/ADVANCED

Sales/Negotiating collaboratively/MASTERY

Service/Creating a Differentiated Service Experience/ADVANCED

DESIRED SKILLS

Finance/Delivering Profit and Performance/FOUNDATION

General Business/Demonstrating Business and Industry Acumen/ADVANCED

General Business/Turning Data into Information/ADVANCED

Telework Specifications:

Location can be at one of the offices in Texas: Houston, Sugar Land, San Antonio or Austin

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 candidates'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.

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Job Function: Health Care