Network Manager Local Lead (60186BR)Primary Location: Phoenix, Arizona
Additional Locations: AZ-Phoenix, AZ-Scottsdale, CA-Sacramento, CA-San Diego, LA-Kenner, LA-New Orleans, TX-Dallas, TX-Houston, TX-San Antonio, WA-Kent, WA-Seattle Apply
This role will support our local health plans in the following states: Texas, Louisiana, California, Washington and Arizona. Negotiating, executing and closing contracts with small and large providers such as (Hospitals, PCPs, OBGYN, etc) who are part of our local Medicaid health plans. Opportunity will focus on supporting our existing networks, brand new market builds and expansion opportunities. Value Base Solutions contracting and network recruitment will be key success factors for this role to support specific healthcare needs for our members.
Our preferred applicants will reside in 1 of these states: Texas, Louisiana, California, Washington or Arizona and will have the ability to work from home full time. Travel will be necessary but not too much 10%-15% of the time.
(*) Negotiates, executes and closes contracts from smaller to larger more complex providers at the local market-level group/system providers for Aetna Better Health Plans
(*) Works closely with and supports our Network Managers for each western health plan
(*) 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.
(*) May optimize interaction with assigned providers and internal business partners to manage relationships to ensure provider needs are met.
(*) 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.
(*) Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information. Background Experience: (*) Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.
(*) Value Base Solution contracting experience
(*) 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.
(*) Strong communication, critical thinking, problem resolution and interpersonal skills.
(*) Bachelor’s Degree or equivalent combination of education and experience. Functional Skills: Network Management - Contract negotiation, Network Management - Physician recruiting - medical, Network Management - Provider relations Technology Experience: Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft SharePoint, Desktop Tool - TE Microsoft Excel Potential Telework Position: Yes Percent of Travel Required: 0 - 10% 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 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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