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Aetna Senior Network Manager in Houston, Texas

Req ID: 65489BR

Job Description

Qualified candidates across the country will be considered for this remote opportunity

Accountable for designing national complementary alternative medicine program, developing and implementing multiple network based vendor programs, including designing conceptual models, initiative planning, and negotiating high value/risk contracts with vendors in accordance with company standards. Develops the plans and leads the work, meeting deliverables of multiple complex projects or programs, through all aspects of implementation, including impacts to multiple processes, systems, functions, products, and business areas. Work cross-functionally to ensure consistency with all contracting strategies, meeting and exceeding accessibility, quality, compliance, and financial goals and cost initiatives. Manages contract performance, and drives the development and implementation of value based contract relationships in support of business strategies


Fundamental Components included but are not limited to:

Develops and drives strategic plans and holistic solutions to achieve business goals. Negotiates and executes contracts with the most complex regional/national vendors with significant financial implications. Manages contract performance and drives development adnd implementation of value based contract relationships in support of business strategies. Collaborates and partners with other functional managers, business areas, local markets to ensure all workflow processes and interdependencies are identified and addressed. Consults with constituents and stakeholders (internal and external) to scope and define projects. Collaboratively works across multiple functions and business areas to obtain agreement from all impacted parties (e.g., up and downstream effected areas, functions, and constituents). Builds strong relationships with internal and external constituents and stakeholders to achieve results. Demonstrates a strong working knowledge of company policies, systems, and patient management initiatives. Leads multiple implementations of new programs spanning various specialty benefit care management solutions regarding ancillary and alternative medicine with aggressive timelines simultaneously. Supports and collaborates with others to ensure program expansions lead to program success, market differentiation, and reduced medical costs. Provides analysis of business implications; applies critical thinking skills. Accountable for cost arrangements within defined programs. 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 collaborating cross functionally to execute significant cost saving initiatives. Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners. Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements. Collaborates 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. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.

Qualifications Requirements and Preferences:

Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements. 7+ years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems. Experience with ancillary networks and / or alternative medicine programs preferred. Strong communication, critical thinking, problem resolution and interpersonal skills. Bachelor s Degree or equivalent combination of education and experience.

Functional Skills:

General Management - Vendor management (non-IT), Management - Management - Health Care Delivery, Management - Management - Operations, Management - Management - Project management (non-IT), Network Management - Contract negotiation

Technology Experience:

Aetna Application - Enterprise Provider Database System, Aetna Application - Strategic Contracts Manager

Required Skills:

General Business - Applying Reasoned Judgment, Leadership - Collaborating for Results, Leadership - Developing and Executing Strategy

Desired Skills:

Finance - Profit and Quality Vigilance, General Business - Ensuring Project Discipline, Leadership - Creating Accountability

Additional Job Information:

This is an exciting opportunity to build a program focused on holistic alternative medicine. Experience contracting risk/capitated arrangements required. Experience with ancillary service provider networks and programs, including alternative medicine networks and programs desired. Knowledge of product, benefit design, SCM, EPDB, project management and end to end implementations needed. Building relationships and consensus to overcome obstacles needed. A strong ability to initiate and drive work streams to achieve results is critical. Fluid Microsoft desk top application skills, including advanced, Excel expected

Benefit Eligibility

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Healthcare

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.