Aetna Network Manager in Philadelphia, Pennsylvania
Req ID: 42988BR
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. Completes the necessary steps to ensure that contracts are loaded into systems accurately and timely and manages implementation of new contracts with departments involved. - 5 years (min.) of provider contracting experience - Experience with medicaid contracting strongly preferred.
Required Skills: - Load final negotiated contracts into appropriate systems (Mastery) - Analyze and refine provider networks to assure appropriate network composition (Foundation) - Negotiate and manage network contractual arrangements (Mastery) - Negotiate contracts and other understandings on behalf of the company (Mastery) - Utilize PADU guidelines for negotiations (Mastery) - Manage requests for special contractual language (Mastery) - Participates in organizational audits to ensure organizational compliance with regulatory agencies as appropriate. - Evaluates current contracts, renegotiates where applicable, and applies managed care reimbursement principles (capitation, per diems, creative reimbursement, etc.) to maximize cost savings - Manages and develops the skills of department personnel. - Develops and maintains the Health Plan contract templates, including securing all required approvals. - Manages initial and ongoing cost/benefit analysis of contracts to determine cost effectiveness, renegotiating as appropriate. - Manages the process of appropriate legal / regulatory review of contracts prior to execution. - Drafts, recommends and writes both standard and specialized contracts, ensuring that all required components are included. - Ensures networks adequacy and cost effectiveness in accordance with established minimum standards.
Must possess a successful track record negotiating large hospital system contracts.
Must possess a successful track record negotiating large hospital system contracts. Medicaid experience preferred. Philadelphia location is necessary for this position.
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/Physician recruiting - medical/4-6 Years
Functional - Network Management/Provider relations/4-6 Years
Functional - Management/Management - Network Management/4-6 Years
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/4-6 Years/End User
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User
Service/Demonstrating Service Discipline/ADVANCED
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Leadership/Developing and Executing Strategy/ADVANCED
Medicaid Positions #3876 and #3877.
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.
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Job Function: Health Care