Aetna Network Account Manager in Woodland Hills, California
Req ID: 41714BR
Develop strong relationships with key network providers. Collaborate with internal business partners leading to the achievement of provider and member satisfaction, medical cost and network efficiency targets and membership growth. Explains Aetna plans, contract & policy parameters and uses appropriate judgment and knowledge to successfully resolve Provider issues while maintaining compliance as well as not compromising Aetnas mission/goal. Also can negotiate and bind the Company on significant matters as it involves disputes using Company approved parameters. Identify trends and enlist assistance in problem resolution with the appropriate departments if necessary. Participate in claims projects, audits, or other activities needed to identify, address, prevent, and resolve service issues. Strong communication, critical thinking and interpersonal skills. Manage Joint Operating Committee meetings with identified IPA/Medical Groups.
Recruits and negotiates contracts with providers on behalf of the company. (20%) Interacts with networks key physician groups, Integrated Delivery Systems, and hospitals to facilitate solutions that are mutually beneficial for providers and the company. (30%) Collaborates cross-functionally on complex issues to ensure provider needs are met and issues are resolved. (30%) Consistently monitors Aetna service capabilities to collaboratively ensure that provider constituents needs are met. Seeks to optimize provider interaction and provides recommendations based on balance of provider needs and Aetnas objectives. (10%) Collaborates cross-functionally to resolve customer network related issues. (5%) Manages medical cost drivers and executes specific medical cost initiatives to support financial and medical cost objectives. (5%)
Excellent project management and decision-making skills. Multi-functional experience. 2-5 years industry experience. Working knowledge of provider business operations, HCIC website, MCR Files, DocFind, Main Frame, Network Reference Tool, Provider Service Center tickets, EPDB, Smart Front End, Rates Information Tracking Tool and Strategic Contract Manager.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Network Management/Physician recruiting - medical/4-6 Years
Functional - Network Management/Network market leadership/1-3 Years
Technical - Aetna Applications/Aetna Administrative System/1-3 Years/End User
General Business/Demonstrating Business and Industry Acumen/FOUNDATION
Leadership/Collaborating for Results/FOUNDATION
Service/Improving constituent-focused Processes/FOUNDATION
ADDITIONAL JOB INFORMATION
Join an experienced strong team of professionals focused on provider satisfaction in Aetna's Southern California Market
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