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Manager--Dental Network Management-Provider Relations - 69464BR

Primary Location: Detroit, MI
Additional Locations: AZ-Phoenix, AZ-Scottsdale, AZ-Tempe, IL-Chicago, IL-Downers Grove, MI-Detroit, MI-Grand Rapids, MN-Minneapolis, MN-St Paul, OH-Cincinnati, OH-Columbus, OK-Oklahoma City, OK-Tulsa, TX-Dallas, TX-Houston
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Description:
Manages a team of provider/network liaisons that executes, conducts reviews and analysis, dispute resolution and/or settlement negotiations of contracts with dental offices/providers in accordance with company standards to maintain and enhance dental provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives. Maintains accountability for specific dental cost initiatives for assigned region.

Fundamental Components:
Manages a team of professional liaisons and negotiators to negotiate competitive contractual relationships with dental providers according to prescribed guidelines and financial standards in support of national and regional network strategies for assigned region. Manages contract performance and supports the development and implementation of standard and/or value-based contract relationships in support of business strategies to include dental PPO and DMO products. Maintains and services providers as needed to ensure attainment of network expansion and adequacy targets. May manage provider contract support functions including contracts and state filings; contract support, review & approval, and information analysis to ensure the development of cost-effective dental provider contracts. Manages provider compensation/reimbursement and pricing development activities in partnership with business management. Manages the liaisons accountable for cost arrangements within defined regions. 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.Partner with business to determine dental network and contract needs.Responsible for reporting, understanding and managing dental cost issues and initiating appropriate action in partnership with business.Serves as SME for less experienced team members and internal partners. Provides sales and marketing support, community relations and guidance with comprehension of applicable federal and state regulations.May provide dental 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.Initiate legal reviews as needed; ensure all required reviews completed by appropriate functional areas.Required to communicate w/internal/external parties by phone/in person; may require travel to offsite locations.

Background Experience:
5 to 7 years experience in managing dental networks and regional team. A successful track record of managing and negotiating dental provider contracts that improve competitive positioning in depth knowledge of various reimbursement structures and payment methodologies. Solid leadership skills including staff development. Critical thinking and problem solving skills. Bachelor's degree or equivalent experience.
Location: Telework, highly preferred for candidates located in the central and/or southeast region.

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Additional Job Information:
Knowledge of dental DMO and PPO products.
Strong verbal and written communication skills.
Negotiation skills.
Strong leadership skills.
Provider relations management.


Required Skills:
Leadership - Collaborating for Results, Leadership - Creating Accountability, Leadership - Engaging and Developing People, Sales - Managing Competitive Networks, Service - Handling Service Challenges

Desired Skills:
Leadership - Developing and Executing Strategy, Leadership - Driving Change, Service - Creating a Differentiated Service Experience

Functional Skills:
Information Management - Analyzes all types of capitated and fee-for-service provider contracts, performs variance analysis, Network Management - Contract negotiation, Network Management - Provider relations, Products-Dental - All Aetna Dental Products

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Potential Telework Position:
Yes

Percent of Travel Required:
25 - 50%

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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