Aetna Network Relations Manager in Blue Bell, Pennsylvania
Req ID: 49825BR
Acts as the primary resource for assigned profile of larger and more complex providers (i.e. market/ regional/national, large group or hospital systems) to establish, oversee, and maintain provider risk management and positive relationships and supports high value initiative activities. Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency targets. May have limited contract negotiation responsibilities for assigned providers.
*Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships and partners on the development of business strategy and programs to support the operational plans.
*Collaborates cross-functionally to ensure resolution of escalated issues or projects for assigned provider systems and monitors perrformance and adherence to scorecards and payout schedules based on established quality, growth and clinical measures.
*Educates internal and external parties as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, performance measurement techniques, policies, and procedures.
*Meets with key providers periodically to ensure service levels are meeting expectations. Manages the development of agenda, validates materials, and facilitates external provider meetings.
*May collaborate cross-functionally on the implementation of large provider systems, to manage cost drivers, data reports and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution.
*May be responsible for provider recruitment, contracting, or re-contracting activities, or may assist and support more complex contracting and discussions.
*May provide guidance and training to less experienced team members.
*Bachelors Degree or equivalent combination of education and experience.
*4+ years' experience in business segment specific environment servicing or managing non-standard relationships with providers with exposure to benefit plan design and/or contract interpretation.
*Working knowledge of business segment specific codes, products, and terminology.
*3-5 years' experience with business segment specific policy, benefits, plan design and language.
*Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills with proven ability to influence and collaborate with providers and partners at all levels.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Network Management/Provider relations/1-3 Years
Functional - Network Management/Contract negotiation/1-3 Years
Functional - Network Management/Physician recruiting - medical/1-3 Years
Technical - Network/Network management/1-3 Years/End User
Technical - Network/Provider e.connectivity/1-3 Years/End User
Technical - Network/Provider communications & education/1-3 Years/End User
Considered only for locations in Northeastern or Southeastern PA and training period in the office may be required
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.
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