Dir, Network Management
POSITION SUMMARY
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. Manages local network management team.
Fundamental Components:
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 ( )
Assist and facilitate business intent reviews (BIR) ( )
Initiate legal reviews as needed; ensure all required reviews completed by appropriate functional areas ( )
Regional owner of Strategic Contact Manager (SCM) and rate wizard ( )
Act as SME for PRL/Recruiters supporting ancillary and large physician group contracting ( )
May supervise day-to-day operations of network management teams/units ( )
Assist with the design, development, management, and/or implementation of strategic network configurations
Manages local Provider Relationship Management, Organization Orientation, Provider Advocacy
BACKGROUND/EXPERIENCE desired:
Must possess a successful track record negotiating large hospital system contracts.
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
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Managed Care/ is desired
Healthcare Management/ is desired
Leadership/ is desired
Finance/ is desired
FUNCTIONAL EXPERIENCES
Functional - Management/Management - Network Management/7-10 Years
Functional - Leadership//4-6 Years
Functional - Finance//1-3 Years
TECHNOLOGY EXPERIENCES
Technical - Aetna Applications/Strategic Contracts Manager/1-3 Years/End User
REQUIRED SKILLS
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Leadership/Developing and Executing Strategy/ADVANCED
DESIRED SKILLS
Leadership/Engaging and Developing People/ADVANCED
Leadership/Driving Change/ADVANCED
Telework Specifications:
Full-Time Telework (WAH) for an individual living in the NH Market
ADDITIONAL JOB INFORMATION
Exceptional opportunity for a seasoned provider relations, network contractor, and/or strategic network contracting executive.
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.
Employment Type Regular Career Band Description Management
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications.
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. Manages local network management team.
Fundamental Components:
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 ( )
Assist and facilitate business intent reviews (BIR) ( )
Initiate legal reviews as needed; ensure all required reviews completed by appropriate functional areas ( )
Regional owner of Strategic Contact Manager (SCM) and rate wizard ( )
Act as SME for PRL/Recruiters supporting ancillary and large physician group contracting ( )
May supervise day-to-day operations of network management teams/units ( )
Assist with the design, development, management, and/or implementation of strategic network configurations
Manages local Provider Relationship Management, Organization Orientation, Provider Advocacy
BACKGROUND/EXPERIENCE desired:
Must possess a successful track record negotiating large hospital system contracts.
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
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Managed Care/ is desired
Healthcare Management/ is desired
Leadership/ is desired
Finance/ is desired
FUNCTIONAL EXPERIENCES
Functional - Management/Management - Network Management/7-10 Years
Functional - Leadership//4-6 Years
Functional - Finance//1-3 Years
TECHNOLOGY EXPERIENCES
Technical - Aetna Applications/Strategic Contracts Manager/1-3 Years/End User
REQUIRED SKILLS
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Leadership/Developing and Executing Strategy/ADVANCED
DESIRED SKILLS
Leadership/Engaging and Developing People/ADVANCED
Leadership/Driving Change/ADVANCED
Telework Specifications:
Full-Time Telework (WAH) for an individual living in the NH Market
ADDITIONAL JOB INFORMATION
Exceptional opportunity for a seasoned provider relations, network contractor, and/or strategic network contracting executive.
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.
Employment Type Regular Career Band Description Management
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications.
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