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Director, Network Management

Primary Location: New York, New York
Additional Locations: NY-New York
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Description:
Acts as Network operations director and coordination point across all business partners for the New York and New Jersey market. Key internal role responsible for maintaining efficient network operations. Manages all aspects of non-contracting local network operations for the New York/ New Jersey market to include policy interpretation and implementation, provider data integrity, efficient management and resolution of network related issues, primary contact for executive compliant team, quality control of credentialing and delegation management workflows and supports various activities associated with network filings, new product/network launch activities, product network compliance and dispute resolution/ litigation. This position reports to the Chief Network Officer for New York/New Jersey market.

Fundamental Components:
Manage team of local market network operations resources
Responsible for driving efficiency and work flow improvements in local market network operations
Partners closely with National Network functions including CCU, Provider Service Operations, Data Services and Compliance
Collaborates with internal stakeholders to support network development, maintenance, refinement activities, regulatory filings and migration activities
Promotes operational excellence and leads improvement initiatives related to Provider Experience
Manages and maintains accuracy of provider data in collaboration with Provider Data Operations organization
Compiles/prepares case files (e.g., analytics, paperwork, etc.) and manages independent provider dispute resolution process;
Supports Chief Network Officer in partnership with Legal, in due diligence and management of litigation (e.g., panels, hearings, depositions, arbitration, court appearances)
Responsible for understanding and implementation of policy changes and assessing how changes impact network strategy
Specific focus and priorities of role as dictated by unique market environment and needs and priorities

Background Experience:
10+ Years’ Experience in Network Contracting/Provider Services
Deep knowledge of health care industry, policy, research design, project management
Advanced technical, analytic and consultative skills, extensive knowledge of health care data and information systems, as well as an understanding of provider reimbursement methods, health care benefits, health care financing and health care delivery systems
Analytical ability, communications skills, judgment, integrity and organizational skills in managing cases, projects and assignments
Provides leadership in influencing sound business decisions based on data, results and information derived from industry trends, research findings, and enterprise-specific reports and analyses
Builds and maintains positive, productive relationships with internal and external constituents at all organizational levels, and is able to remove significant barriers, drive decision-making and influence ethical and compliant outcomes at all organizational levels necessary to accomplish goals

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:
Leadership - Anticipating and Innovating, Leadership - Collaborating for Results, Leadership - Engaging and Developing People

Desired Skills:
Leadership - Creating a World Class Workforce, Leadership - Creating Accountability, Leadership - Driving Strategic and Organizational Agility

Potential Telework Position:
No

Percent of Travel Required:
10 - 25%

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

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this 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

Click To Review Our Benefits (PDF)

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