Aetna Network Manager (Role could be based in Singapore OR Hong Kong) - 52045BR in Hong Kong, Hong Kong
Req ID: 52045BR
Summary/MissionDesign, develop, contract, maintain and enhance relationships with facilities, physicians and ancillary providers which serve as contractual networks of care for members; foster growth of managed care products; and enhance profitability of Aetna. Position Summary/Mission· Negotiates, executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.· Fundamental Components & Physical Requirements include but are not limited to (* denotes essential functions)· 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.
Fluency in English and any of the following languages will be a plus (due to managing relations with international providers): Thai / Bahasa Indonesia / Vietnamese / PhilippinoEducation and Certification RequirementsBachelor s Degree or equivalent combination of education and experience. #LI-BR1
Job Function: Health Care