Aetna Senior Network Manager in Louisville, Kentucky
Req ID: 56192BR
Accountable for designing conceptual models, initiative planning, and negotiating high value/risk contracts with the most complex and challenging, market/region/national, largest group/system 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.
Drives or guides development of holistic solutions or strategic plans.
Negotiates and executes contracts with the most complex, market /region/national, largest group/system or highest value/volume of spend providers with significant financial implications.
Manages contract performance, and drives 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 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.
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/7-10 Years
Functional - Network Management/Physician recruiting - medical/7-10 Years
Functional - Network Management/Provider relations/7-10 Years
Functional - Network Management/Provider data services/4-6 Years
Technical - Desktop Tools/Microsoft Word/7-10 Years/
Technical - Desktop Tools/Microsoft Outlook/7-10 Years/
Technical - Desktop Tools/Microsoft PowerPoint/7-10 Years/
Technical - Desktop Tools/Microsoft SharePoint/4-6 Years/
Finance/Delivering Profit and Performance/ADVANCED
Sales/Managing Competitive Networks/MASTERY
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Leadership/Engaging and Developing People/FOUNDATION
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.
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.