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A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Network Manager (57691BR)

Primary Location: Louisville, Kentucky
Additional Locations: KY-Louisville
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POSITION SUMMARY
Acts as the primary resource for assigned profile of larger and more complex providers (i.e. market/ regional/national, large group or hospital systems) to establish, oversee, and maintain provider risk management and positive relationships and supports high value initiative activities. Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency targets.Will have contract negotiation responsibilities for assigned providers.

Fundamental Components:
Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships and partners on the development of business strategy and programs to support the operational plans.
Collaborates cross-functionally to ensure resolution of escalated issues or projects for assigned provider systems and monitors performance and adherence to scorecards and payout schedules based on established quality, growth and clinical measures.
Educates internal and external parties as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, performance measurement techniques, policies, and procedures.
Meets with key providers periodically to ensure service levels are meeting expectations. Manages the development of agenda, validates materials, and facilitates external provider meetings. Act as Subject Matter Expert (SME) resource for other team members. Collaborates with the Population Health position in identifying improved outcome opportunities.

BACKGROUND/EXPERIENCE desired:
Bachelors Degree or equivalent combination of education and experience.
Working knowledge of business segment specific codes, products, and terminology.
3-5 years' experience with business segment specific policy, benefits, plan design and language.
Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills with proven ability to influence and collaborate with providers and partners at all levels.
4+ years' experience in business segment specific environment servicing or managing non-standard relationships with internal and external clients with exposure to benefit plan design and/or contract interpretation.

EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

FUNCTIONAL EXPERIENCES
Functional - Claims//4-6 Years
Functional - Network Management//4-6 Years
Functional - Customer Service//4-6 Years


TECHNOLOGY EXPERIENCES
Technical - Aetna Applications//1-3 Years/End User
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/


ADDITIONAL JOB INFORMATION
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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Click To Review Our Benefits (PDF)

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