Aetna Senior Network Manager in St Louis, Missouri
Req ID: 41188BR
This position is located in Phoenix, AZ (candidates can work remotely in/around Phoenix once hired).
Negotiates, competitive and complex contractual relationships with hospitals, large physician groups and ACO's according to pre-determined internal guidelines and financial standards. Works cross-functionally to execute network strategies. Maintains accountability for specific medical cost initiatives. Design, develop, contract, maintain and enhance relationships with facilities, physicians and ancillary providers which serve as contractual networks of care for members; foster growth of managed care products; and enhance profitability of Aetna.
Effectively negotiates complex, competitive contractual relationships with hospitals, large physician groups and ACO's according to prescribed guidelines in support of national and regional network strategies () Promotes alternative provider payment methodologies (P4P, bundled payments, at risk arrangements) in support of value based contracting initiatives () 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 track record negotiating large hospital system contracts.
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/4-6 Years
Functional - Network Management/Physician recruiting - medical/4-6 Years
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/4-6 Years/End User
Technical - Aetna Applications/Strategic Contracts Manager/4-6 Years/End User
General Business/Demonstrating Business and Industry Acumen/ADVANCED
General Business/Turning Data into Information/MASTERY
Service/Demonstrating Service Discipline/ADVANCED
Leadership/Developing and Executing Strategy/ADVANCED
Sales/Managing Competitive Networks/MASTERY
Option for part-time telework will be evaluated after a certain period of employment. Part-Time Telework (ex: 3 days office-based, 2 days telework)
ADDITIONAL JOB INFORMATION
Comprehensive understanding of hospital and physician financial issues, value based contracting and how to leverage technology to achieve quality and cost improvements for both payers and providers.
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