Aetna Provider Network Engagement Manager (Maryland's Eastern Shore) (55061BR) in Hagerstown, Maryland

Req ID: 55061BR

POSITION SUMMARY

This position is responsible for managing an effective relationship with providers in the Aetna Better Health of Maryland Provider Network on Maryland's Eastern Shore.

This is a remote work opportunity, but you must live within commuting distance of Maryland's Eastern Shore to be considered.

Fundamental Components:

This position is for a dynamic individual who will:

Optimize interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships and partners on the development of business strategy and programs to support the operational plans.

Collaborate cross-functionally to ensure resolution of escalated issues or projects for assigned provider systems and monitor performance and adherence to scorecards and payout schedules based on established quality, growth and clinical measures.

Educate internal and external parties as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, performance measurement techniques, policies, and procedures.

Meet with key providers periodically to ensure service levels are meeting expectations. Manage the development of agenda, validate materials, and facilitate external provider meetings.

May collaborate cross-functionally on the implementation of large provider systems, to manage cost drivers, data reports and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution.

May be responsible for provider recruitment, contracting, or re-contracting activities, or may assist and support more complex contracting and discussions.

They will work independently and will be responsible for providing guidance and training to less experienced team members.

BACKGROUND/EXPERIENCE desired:

4+ years experience in business segment specific environment servicing or managing non-standard relationships with providers with exposure to benefit plan design and/or contract interpretation.

Working knowledge of business segment specific codes, products and terminology.

3-5 years' experience with business segment specific policy, benefits, plan design and language.

Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills with proven ability to influence and collaborate with providers and partners at all levels.

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.

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/Provider relations/7-10 Years

Functional - Network Management/Contract negotiation/7-10 Years

Functional - Network Management/Physician recruiting - medical/7-10 Years

Functional - Network Management/Credentialing/4-6 Years

Functional - Claims/Claim processing - Medical or Hospital- HMO/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Exchange/7-10 Years/End User

Technical - Desktop Tools/Microsoft PowerPoint/7-10 Years/End User

Technical - Desktop Tools/Microsoft Project/4-6 Years/End User

Technical - Desktop Tools/Microsoft Word/More Than 10 Years/End User

ADDITIONAL JOB INFORMATION

We are looking for an individual that lives on the Maryland' Eastern Shore. This will allow the employee to work from their home 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 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

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.