Aetna Network Relations Mgr in Doral, Florida
Req ID: 55154BR
Acts as the primary resource for assigned specialty capitated vendors to establish, oversee, and manage vendor relationships and supports all day to day operations, contracting, servicing and financial performance. Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency targets. May have limited contract negotiation responsibilities for assigned providers.
Optimizes interactions with assigned specialty capitated vendors and internal business partners to establish and maintain productive, professional relationships and partners on the development of business strategy and programs to support the operational plans. Collaborates cross-functionally to ensure resolution of escalated issues or projects for assigned provider partners and monitors performance and adherence to scorecards and payout schedules based on established quality, growth and clinical measures. Educates internal and external parties as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, performance measurement techniques, policies, and procedures. Meets with key providers periodically to ensure service levels are meeting expectations. Manages the development of agenda, validates materials, and facilitates external provider meetings. May collaborate cross-functionally on the implementation of large provider systems, to manage cost drivers, data reports and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution. May be responsible for provider recruitment, contracting, or re-contracting activities, or may assist and support more complex contracting and discussions. May provide guidance and training to less experienced team members.
4+ years' experience in Medicare specialty capitated networks. Experience must include contracting, servicing and management of networks. Working knowledge of business segment specific codes, products, terminology and capitation methodologies. Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills with proven ability to influence and collaborate with providers and vendors at all levels.
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/Provider relations/7-10 Years
Functional - Network Management/Provider data services/7-10 Years
Functional - Information Technology/Project management/4-6 Years
Technical - Desktop Tools/Microsoft Exchange/7-10 Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/7-10 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/7-10 Years/End User
Technical - Desktop Tools/Microsoft Outlook/7-10 Years/End User
Option for potential telework will be evaluated after a certain period of employment
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.