Aetna Network Manager - 44298BR in Houston, Texas

Req ID: 44298BR

POSITION SUMMARY:

Effectively negotiates competitive and complex contractual relationships with providers and/or business partners in Latin, Central and South America in support of international network, medical cost management and overall claim/customer service strategies. Provides concierge level of service to our members via timely provision of required network access and proactive management of network relationships to ensure seamless, cost effective direct settlement access.

Fundamental Components:

  • Effectively negotiates and manages complex, competitive contractual relationships with providers/vendors according to prescribed guidelines in support of global and regional network strategies.

  • Manage day to day provider operations. Ensures operational efficiency for all network processes and infrastructure through proactive provider education and collaboration with Aetna International Service Operations.

  • Executes regional-specific strategies and tactics in response to market expectations.

  • Executes client-specific strategies and tactics for key expatriate clients.

  • Collaborate with regional peers to effect overall global strategy.

  • Responsible for understanding and managing medical cost issues and initiating appropriate action from the provider perspective.

  • Key contributor to enhanced provider service solution, including development and/or management of process and technical solutions; and provider education and compliance.

  • Initiate legal reviews as needed; ensure all required contractual reviews are completed by appropriate functional areas.

    BACKGROUND/EXPERIENCE desired:

  • Written/verbal proficiency in Spanish required.

  • Must possess a successful track record negotiating and managing hospital, physician specialist, ancillary providers and vendor agreements.

  • Ability to use management information to manage networks and achieve cost economies.

  • Strong project management skills.

  • Excellent written and verbal communication skills.

    EDUCATION:

    The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

    LICENSES AND CERTIFICATIONS:

    Healthcare Management/ is desired

    Project Management/ is desired

    Leadership/ is desired

    Business/ is desired

    FUNCTIONAL EXPERIENCES:

    Functional - Network Management/Contract negotiation/4-6 Years

    Functional - Network Management/Provider relations/4-6 Years

    Functional - General Management/Vendor management (non-IT)/4-6 Years

    Functional - General Management/Vendor management (non-IT)/4-6 Years

    REQUIRED SKILLS:

    Benefits Management/Interacting with Medical Professionals/MASTERY

    General Business/Demonstrating Business and Industry Acumen/ADVANCED

    Sales/Managing Competitive Networks/MASTERY

    DESIRED SKILLS:

    Leadership/Developing and Executing Strategy/ADVANCED

    Sales/Negotiating collaboratively/MASTERY

    Service/Demonstrating Service Discipline/ADVANCED

    Telework Specifications:

    CAN BE BASED IN FLORIDA OR ANY US LOCATION. Southeast USA preferred. Work at home situation will only be considered for current employees who have proven track record of success.

    ADDITIONAL JOB INFORMATION:

    Opportunity to work in a fast paced, growing and exciting international arena supporting key Aetna International clients.

    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 candidate'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