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Provider Contracting Manager

Primary Location: Phoenix, Arizona
Additional Locations: AZ-Phoenix
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Description:

Negotiates, executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers in accordance with company standards.

Responsible for complex provider contracting and negotiations (primarily hospitals, skilled nursing facilities, Value
Base Solutions and Capitation). Design, develop, maintain and enhance relationships all provider types and specialties which serve as contractual networks for members.
Negotiates competitive and complex contractual relationships with providers according to organizational guidelines and financial standards. Works cross-functionally to execute network strategies.



Fundamental Components:
Negotiates and executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market-based, group/system providers. 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. Accountable for cost arrangements within defined groups. 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 SME 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.

Background Experience:
Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.
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.
Master's or Bachelor’s Degree preferred or equivalent combination of education and experience.

Additional Job Information:

Has the ability to manage
multiple tasks, good written/oral communication, and organizational skills. Team
player and work well with others. Proficiency and functional experience in
Microsoft Excel, Word, Power Point, Share Point, and Outlook. Must have proficiency of 3-Intermediate (practical application), 4 - Advanced (applied theory), 5 - Expert (recognized authority)


Must possess a successful
track record leading and finalizing negotiations (Closer) of all provider types:
Hospitals, SNF, HCBS, Ancillary, Behavioral Health, Physicians and Dentist.
Understanding of contract management, rules, compliance, and Value Base Solutions.
Able to communicate with all levels of management: C-Suites, VP level and
Director/ Manager levels. Knowledge of all AZ Medicaid (AHCCCS) programs.



Required Skills:
Leadership - Collaborating for Results, Leadership - Creating Accountability, Leadership - Developing and Executing Strategy, Leadership - Driving a Culture of Compliance

Desired Skills:
Leadership - Driving a Culture of Compliance, Leadership - Driving Change, Leadership - Driving Strategic and Organizational Agility, Sales - Negotiating Collaboratively, Service - Demonstrating Service Discipline

Functional Skills:
Acturial - Product development, Acturial - Research, Clinical / Medical - General Management, Clinical / Medical - Network management, Clinical / Medical - Precertification

Potential Telework Position:
No

Percent of Travel Required:
50 - 75%

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.

Click To Review Our Benefits (PDF)

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