Aetna Senior Network Manager in Fresno, California

Req ID: 52755BR


Accountable for designing conceptual models, initiative planning, and negotiating high value/risk contracts with the most complex and challenging, market/region/national, largest group/systems or highest value/volume of spend providers in accordance with company standards in order to maintain and enhance provider networks, while working cross functionally to ensure consistency with all contracting strategies and meeting and exceeding accessibility, quality, compliance, and

financial goals and cost initiatives.


Fundamental Components:

Drive or guide development of holistic solutions or strategic plans negotiate and execute contracts with the most complex, market /region/national, largest group/system or highest value/volume of spend providers with significant financial implications.Manage contract performance, and drives the development and implementation of value based

contract relationships in support of business strategies.Recruit providers as needed to ensure attainment of network

expansion and adequacy targets.Accountable for cost arrangements within defined groups. Collaborate 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 collaborating cross functionally to execute significant cost saving initiatives.Represent company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners.Evaluate, helps formulate, and implement the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.Collaborate with internal partners to assess effectiveness of tactical plan in managing costs.May optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.Ensure resolution of escalated issues related, but not limited to, claims payment, contract

interpretation and parameters, or accuracy of provider contract or demographic information.


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

7+ years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems.

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


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


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


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

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

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


Benefits Management/Interacting with Medical Professionals/MASTERY

General Business/Demonstrating Business and Industry Acumen/ADVANCED

Sales/Negotiating collaboratively/MASTERY


General Business/Turning Data into Information/MASTERY

Service/Demonstrating Service Discipline/ADVANCED

Technology/Leveraging Technology/MASTERY

Telework Specifications:

Medicaid Position #5514


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.

Job Function: Health Care