Network ManagerPrimary Location: Harrisburg, Pennsylvania
Additional Locations: PA-Harrisburg Apply
Negotiates, executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of hospital and hospital owned physician and ancillary contracts in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals.
--Negotiates, executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of hospital and hospital owned physician and ancillary contracts in accordance with company standards.
--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.
--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 subject matter expert 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.
--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.
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 - Network Management/Provider relations/4-6 Years
Technical - Aetna Applications/Strategic Contracts Manager/1-3 Years/End User
Technical - Aetna Applications/Enterprise Provider Database System/1-3 Years/End User
Technical - Aetna Applications/Smart Front End/1-3 Years/End User
Benefits Management/Interacting with Medical Professionals/MASTERY
Finance/Delivering Profit and Performance/FOUNDATION
Leadership/Developing and Executing Strategy/ADVANCED
Finance/Servicing Customers Profitably/MASTERY
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Leadership/Engaging and Developing People/FOUNDATION
Option for telework will be evaluated after a certain period of employment. Telework considered only for unique circumstances.
ADDITIONAL JOB INFORMATION
--Ability to work with both internal and external constituents in negotiating contracts with complex and large health systems in the Central PA market.
--Growth opportunity to excel within the Network Management department or other departments within Aetna.
--Exposure to both Aetna and Coventry commercial, Medicare and national account lines of business.
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'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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