Aetna Network Manager in Nashville, Tennessee
Req ID: 41109BR
Negotiates, competitive and complex contractual relationships with larger and more complex, market based group/system providers in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.
Primary focus on the development of TN's Medicare network and associated products.
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
Initiate legal reviews as needed; ensure all required reviews completed by appropriate functional areas
Must possess a successful track record negotiating large hospital system contracts.
Experience with value based contracting.
Comprehensive understanding of CMS Rules and regulations
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Network Management/Contract negotiation/4-6 Years
Functional - Network Management/Network market leadership/4-6 Years
Functional - Network Management/Provider relations/4-6 Years
General Business/Turning Data into Information/ADVANCED
Leadership/Driving a Culture of Compliance/ADVANCED
ADDITIONAL JOB INFORMATION
Preferred candidate will enjoy working in a team environment with other network staff who are committed to achieving business excellence and living The Aetna Way.
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