Aetna Network Manager in Plano, Texas
Req ID: 46665BR
Develop, contract, maintain and enhance relationships with larger and more complex facilities, ancillaries and groups in order to maintain and enhance provider networks in support of business goals.
Serve as network SME in designated states, collaborating with Aetna local market and national ancillary contracting staff, as well as First Health sales and Account Management leads.
Effectively recruit, negotiate and maintain complex, competitive contractual relationships with First Health direct providers in designated states in support of business strategies
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
Assist with the design, development, management, and/or implementation of strategic network configurations to support business strategy and customer acquisition
Provide 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.
Serve as SME for Provider Relations and Account Management staff, and mentor less experienced network team members as appropriate.
As necessary,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.
Exhibits the following Network Manager Behaviors.
6-10+ years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with complex provider systems or groups.
Strong communication, critical thinking, negotiation, problem resolution and interpersonal skills.
Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.
Team player who wants to work individually and collectively to expand and improve our network and drive business growth.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Champaign, IL, Plano, TX. Denver, CO., In office part time preferred but 100% tele-work acceptable for an experienced candidate.
ADDITIONAL JOB INFORMATION
This key team member and FL market SME will directly contribute to achieving business growth goals via expanding the First Health network and improving contract performance.
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.
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Job Function: Health Care