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Director, Network Management

Primary Location: Burr Ridge, IL
Additional Locations: IL-Burr Ridge
Leads and manages teams of employees who develop, negotiate, contract, and enhance provider networks of high quality, are cost efficient and will improve healthcare for our customers. Oversees the development of programs to maintain and enhance collaborative provider relationships and operational effectiveness. Maintains accountability for related compliance, quality and financial goals.Manages a high functioning team responsible for ensuring overall network competitiveness and profitability for a given geographical area or assigned provider type. The Director’s responsibility and complexity may vary by market size and the need for units may be organized around services such as hospitals, providers, providers, or both; the type of contract, such as fee for service or value based, compliance functions and or cost management efforts.

Fundamental Components:
Leads a team of Network Managers, Consultants and Contract Negotiators who design, develop, manage and/or implement strategic network configurations and effective managed care network relationships.Manages the activities of the network development team, including effective strategies to build progressive provider partners and relationships.Effectively negotiates the most complex, competitive contractual relationships with providers according to prescribed financial guidelines with all provider types including at risk, IPA/IPO, hospital and large provider/provider groups. Ensures necessary review; oversee and support network filings in compliance with state and federal regulations.May include value-based agreements depending on market requirements.Accountable for cost arrangements and contract performance in support of network quality, availability and financial strategies to achieve P-Model, discounts and cost management goals.Ensures network coverage adequacy and implements action items to close gaps.Responsible for advancing the adoption of value-based payment models. May work with VBC Engagement managers to develop VBC arrangements and collaborative agreements.Develops and presents value proposition; presents the potential for network performance results in sales meetings or to external constituents.Analyzes data and is responsible for understanding medical cost issues and trends; collaborates with Medical Economics to monitor and identify scorable action plans; works closely with Population Health to enable and improve clinical outcomes.May oversee Network Relations teams that manage the service needs for providers including network/provider relations policy, recruitment, education and training, as well as improved workflows.Required to communicate w/internal/external parties by phone/in person; may require travel to offsite location.

Background Experience:
8 – 10 years related experience.
Related experience in health operations, network relations and development, command of financials and pricing strategies, and sales interface.
Experience building and maintaining relationships with provider systems.
A successful track record managing and negotiating major provider contracts.
In depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers.
Knowledge and experience with value based contracting and accountable care models.
In-depth knowledge of managed care business, regulatory /legal requirements.
Solid leadership skills, including staff development and talent management.
Bachelors degree or equivalent work experience, MBA/Masters degree preferred.

Additional Job Information:
Job description may also be used for other products besides Commercial medical: e.g., dental, worker’s comp, behavioral health, Medicare, Medicaid, etc.; systems and tools mentioned in the description would align and reflect appropriate product, segment.

Required Skills:
General Business - Demonstrating Business and Industry Acumen, General Business - Maximizing Work Practices, Leadership - Collaborating for Results

Desired Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, Leadership - Driving a Culture of Compliance

Functional Skills:
General Management - Multi-functional management: > 25 employees, Network Management - Contract negotiation, Network Management - Credentialing

Potential Telework Position:

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position.

Candidate Privacy Information:
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.


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