Aetna Senior Network Provider Manager in Westchester, Illinois
Req ID: 44700BR
Qualified Candidates will be in Northern IL
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.
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
Act as SME for contracting staff supporting ancillary and large physician group contracting
Assist with the design, development, management, and/or implementation of strategic network configurations
Interacts with external providers regarding complex nonstandard medical situations
Must possess a successful track record negotiating large, complex integrated delivery system contracts.
Must possess a successful track record of launching and negotiating value-based contracting initiatives.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Network Management/Contract negotiation/More Than 10 Years
Functional - Network Management/Provider relations/More Than 10 Years
Functional - Network Management/Network market leadership/4-6 Years
Functional - Project Management/Plan development/4-6 Years
Functional - Project Management/Project Leader/4-6 Years
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Leadership/Developing and Executing Strategy/ADVANCED
Benefits Management/Interacting with Medical Professionals/MASTERY
General Business/Turning Data into Information/MASTERY
Full-Time Telework (WAH)
Considered only for locations in a specific region, state, or city; training period in the office may be required-Must reside in Northern Illinois
ADDITIONAL JOB INFORMATION
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.
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