Aetna Director, Network Management (Value-Based Contracting) 44357BR in Champaign, Illinois
Req ID: 44357BR
Negotiates competitive and complex contractual relationships with providers according to pre-determined internal guidelines and financial standards. Works cross-functionally to execute network strategies. Maintains accountability for specific medical cost initiatives with an emphasis on executing productive Value Based Contracts to support Medicare market expansion efforts. Manages local network management team of engagement managers.
Fundamental Components & Physical Requirements include but are not limited to: (denotes essential functions) 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 () Act as SME for PRL/Recruiters supporting ancillary and large physician group contracting (*) Assist with the design, development, management, and/or implementation of strategic value based relationships with strategic partners Comprehensive understanding of hospital and physician financial issues and how to leverage technology to achieve quality and cost improvements for both payers and providers. In-depth knowledge of managed care business, regulatory /legal requirements, products, programs, strategy and objectives.
Must possess a successful track record negotiating large hospital system contracts. Strong analytical ability, attention to detail, successful launch and maintenance of strategic VBC arrangements to support collaborative partnerships, ability to influence partners through the use of effective data presentation.
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 - Products-Medical/All Aetna Standard Plans/
Functional - Leadership//1-3 Years
Technical - Aetna Applications/Strategic Contracts Manager/1-3 Years/
Leadership/Developing and Executing Strategy/ADVANCED
Sales/Managing Competitive Networks/MASTERY
Benefits Management/Interacting with Medical Professionals/MASTERY
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 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