Aetna Network Manager in Augusta, Maine
Req ID: 43833BR
This position is a technically advanced position in the field of healthcare contracting on the payer side. This position is responsible for all contractual and rate negotiations with large Independent Physician Offices, Hospital Facilities and Hospital Systems, while maintaining exceptional provider relationships.
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 (*)
Must possess a successful, 5-7 year, track record negotiating large IPA and hospital system contracts
Bachelor's Degree Required
Knowledge and use in data and reporting systems
Excellent Professional Presentation Skills
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
Leadership/ is desired
Communications/ is desired
Project Management/ is desired
Functional - Network Management//4-6 Years
Functional - Customer Service//7-10 Years
Functional - Project Management//4-6 Years
Functional - Information Management//1-3 Years
Functional - Legal//1-3 Years
Technical - Aetna Applications/Strategic Contracts Manager/1-3 Years/
Technical - Database//1-3 Years/
Technical - Network/Network management/4-6 Years/
Service/Creating a Differentiated Service Experience/ADVANCED
Sales/Managing Competitive Networks/MASTERY
Leadership/Driving a Culture of Compliance/ADVANCED
Technology/Selecting and Applying Technology Solutions/ADVANCED
Leadership/Developing and Executing Strategy/ADVANCED
Flexible telework / office-based schedule - must be within commuting distance to the South Portland, Maine office.
ADDITIONAL JOB INFORMATION
Looking for a candidate who wants to join a fast pace, successful and engaging healthcare team to continue to develop and grow our existing outstanding provider relationships. Looking for a candidate who is committed to improving healthcare for all our members through collaboration with our Provider Partners.
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