Aetna Network Manager (N Carolina Market) - 53271BR in Charlotte, North Carolina
Req ID: 53271BR
THIS IS NOT AN IT POSITION POSITION SUMMARY
Do you want to part of changing healthcare? Are you experienced in network management, contract negotiations? Our North Carolina Network Management team is looking for driven individual to join their Local Market Network team. In this role the candidate will 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. #WeJoinYou #AetnaCareersFundamental Components:· Negotiates and executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market-based, group/system providers. · Manages contract performance and supports the development and implementation of value based contract relationships in support of business strategies. · Recruits providers as needed to ensure attainment of network expansion and adequacy targets. · Accountable for cost arrangements within defined groups. · Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities. · Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activities. · Serves as SME for less experienced team members and internal partners. · Provides network development, maintenance, and refinement activities and strategies in support of cross-market network management unit. · Assists with the design, development, management, and or implementation of strategic network configurations and integration activities. · May optimize interaction with assigned providers and internal business partners to manage relationships to ensure provider needs are met. · Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.BACKGROUND/EXPERIENCE desired:· 5+ years of related experience in contracting and/or network management (insurance or hospital based experience strongly preferred)· Must possess a successful track record negotiating large hospital system contracts and developing relationships.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Aetna/Emerging Leaders is desired
Functional - Network Management/Contract negotiation/4-6 Years
Functional - Network Management/Physician recruiting - medical/1-3 Years
Functional - Network Management/Provider relations/1-3 Years
Technical - Aetna Applications/Strategic Contracts Manager/1-3 Years/End User
Technical - Aetna Applications/Enterprise Provider Database System/1-3 Years/End User
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Benefits Management/Interacting with Medical Professionals/MASTERY
Flexible telework / office-based schedule (Must live near Cary, NC, Charlotte, NC, or High Point, NC offices). Will only consider 100% Work At Home for current internal candidates but candidate must be able to visit providers in North Carolina.
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 candidates 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