Aetna Network Manager in Sunrise, Florida
Req ID: 48901BR
Corporate position working with local markets to assist in training and supporting local Network and Engagement Managers with Medicare Value Based contracts.: Overall accountability for the success of assigned value based provider relationships (VBC), including strategic alignment, reference ability, deliverables, and financial and operational success, as measured by both the VBC and by Aetna. Influences and/or manages internal cross-functional groups such as implementation, support, reporting, and enablement, as well as the external client relationships to ensure optimal implementation and performance. Responsible for working with all value-based performance aspects of the engagement/VBC relationship with a team of highly matrixed cross-functional resources. Works with the VBCs executive leadership to ensure financial, technology, clinical, and operational goals are achieved. Responsible for coordinating the development and execution of an annual strategic business plan with Aetna Network Management and each VBC to exceed financial and other appropriate targets.
Develops a mutually beneficial working relationship with various VBCs by consulting on the opportunities, operational design, and implementation of the business strategy while promoting the objectives of improving health care outcomes and increasing patient quality and value. Executes the strategic vision and tone for the VBC relationship and carries out the operational plan to execute that strategy. Seeks to optimize VBC interaction, anticipating VBC needs and acting as the voice of the VBC internally, providing recommendations based on VBC needs. Defines, organizes, influences, and/or leads a team of various internal, and external resources to implement newly negotiated arrangements; ensuring a smooth transition into the intricacies and requirements of the new relationship Collaborates cross-functionally to monitor and optimize VBC performance including clinical, quality, capabilities, and growth as well as financial goals. Looks for ways to enhance the solution within the assigned VBCs to include identifying new functionality, programs, products, services and technology to ensure better outcomes and achievement of program objectives.
Strong communication, critical thinking, problem resolution and interpersonal skills.
5-7 years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with individual or complex provider systems or groups.
Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.
5-7 years of hospital system and/or health insurance industry experience, ACO/managed-care experience preferred. 5-7 years client management experience Previous project management experience in a health plan, health system, or provider organization. Proven ability to interact with, influence, and collaborate with clients 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/Contract negotiation/4-6 Years
Functional - Project Management/Cross-functional project management/4-6 Years
Functional - Network Management/Physician recruiting - medical/4-6 Years
Functional - General Management/Data analysis & interpretation/4-6 Years
Technical - Database/Microsoft Access/1-3 Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User
Finance/Profit and Quality Vigilance/FOUNDATION
Leadership/Developing and Executing Strategy/ADVANCED
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Benefits Management/Interacting with Medical Professionals/MASTERY
Finance/Delivering Profit and Performance/FOUNDATION
General Business/Turning Data into Information/ADVANCED
Work location is not limited to Sunrise, FL. Needs to be an Aetna office.
ADDITIONAL JOB INFORMATION
Abulity to help shape quality improvement in members. Will be responsible for quarterly EM/GM trainings.
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