Aetna Network Manager / Senior Netwo in Seattle, Washington
Req ID: 46300BR
This position is located in our Sandy, Utah office.
This position is responsible for negotiating and administering complex contractual relationships with providers to achieve market leading unit cost position and implement ACO/VBC deals to support population health initiatives. Additionally, this position is also responsible to develop and implement networks and ensure accuracy of provider databases, resolve complicated contract and network issues, and develop and implement medical cost initiatives. This position will either be a Network Manager or Senior Network Manager, depending on the experience and background of the candidate.
Effectively negotiates complex, competitive contractual relationships with providers according to prescribed guidelines in support of national and regional network strategies
Manages provider compensation/reimbursement and pricing development activities
Responsible for understanding and managing medical cost issues and initiating appropriate action
Provides sales and marketing 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
Regional owner of Strategic Contact Manager (SCM) and rate wizard
Act as SME for PRL/Recruiters supporting ancillary and large physician group contracting
May supervise day-to-day operations of network management teams/units
Assist with the design, development, management, and/or implementation of strategic network configurations
Manages local Provider Relationship Management, Organization Orientation, Provider Advocacy
Strong communication, critical thinking, problem resolution and interpersonal skills.
5+ years experience and expert level negotiation skills with successful track record with large complex deals.
Preferred experience includes negotiating and administering deals with large, multi-facility hospital systems.
The highest level of education desired for candidates in this position is a Master's degree.
Network Management/Contract negotiation/4-6 Years
Technical - Desktop Tools/Microsoft Word/4-6 Years/Power User
Developing and Executing Strategy
Creating a Differentiated Service Experience
ADDITIONAL JOB INFORMATION:
This is a critical role for the Aetna Utah Market and will be involved in establishing and managing ACO and other innovative initiatives.
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