Aetna Network Manager in Blue Bell, Pennsylvania
Req ID: 45027BR
Negotiates, competitive and complex contractual relationships with providers according to pre-determined internal guidelines and financial standards. Works cross-functionally to execute network strategies with local markets to support Medicare Advantage expansion plans.
Effectively negotiates facility and ancillary contracts with providers according to prescribed guidelines in support of national and local network strategies Supports the Medicare segment with data reports and access reporting for Medicare Expansion & UAW efforts Manages provider compensation/reimbursement and pricing development activities Responsible for understanding and managing medical cost issues and initiating appropriate action * Provides operational and sales support, community relations and guidance with comprehension of applicable federal and state regulations Assist and facilitate business intent reviews (BIR) Initiate legal reviews as needed; ensure all required reviews completed by appropriate functional areas
4-6 years industry experience. (Medical Cost Drivers and Managed Care Industry) Must possess a successful track record negotiating large hospital system contracts and/or complex facility/Ancillary contracts. Proven ability to execute and complete contracts timely. Exceptional Customer Service Skills. SME Expertise for assigned service line
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Network Management/Contract negotiation/4-6 Years
Functional - Network Management/Credentialing/1-3 Years
Functional - Leadership/Act as company spokesperson to external constituents/4-6 Years
General Business/Turning Data into Information/ADVANCED
Service/Demonstrating Service Discipline/ADVANCED
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Leadership/Driving a Culture of Compliance/ADVANCED
ADDITIONAL JOB INFORMATION
This position will manage Ancillary contracting efforts for the Medicare expansion across the country. This role will require the candidate to have strong interpersonal and communication skills and demonstrate ability to work with many different segments of the organization. Preference for a well-organized individual with a technical understanding of Company systems and policies. Operational experience in support of network management and must be able to manage multiple tasks. Need to demonstrate ability to negotiate and contract with ancillary and facility services.
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