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Director Network Management and Provider Experience (60271BR)

Primary Location: San Diego, California
Additional Locations: CA-San Diego
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Description:
Aetna Better Health of California is hiring a Director Network Management and Provider Experience. Our Network Director will oversees the Provider Experience department under the direction of the COO. Design, develop, contract, maintain sustains and enhance relationships with facilities, physicians , and ancillary providers and internal customers that serve as contractual networks of care for members; foster growth of managed care products; and enhance profitability of Aetna


This position is office based in at our San Diego office location. No option for telework or work from home.


Key success factors are:

(*) Provides daily oversight and leadership to Provider Relations, Network Management, Contracting/ Claims,Credentialing and Provider Data configuration and Provider Data Services teams.
(*) Oversee the development and delivery of regional support functions for local market network operations. (*) Manage provider contract support functions including the development of state filings; contract support, review & approval; and other contract tracking. Ensure the maintenance and integrity of the regional provider data base. (*) Manage the development and delivery of training programs for all aspects of network management, provider contracting, provider service and provider operations and the newly formed Provider Experience Management department.


Fundamental Components:

(*) Leads a team of Network Managers, Consultants and Contract Negotiators who design, develop, manage and/or implement strategic network configurations and effective managed care network relationships.
(*) Manages the activities of the network development team, including effective strategies to build progressive provider partners and relationships.
(*) Effectively negotiates the most complex, competitive contractual relationships with providers according to prescribed financial guidelines with all provider types including at risk, IPA/IPO, hospital and large provider/provider groups.
(*) Ensures necessary review; oversee and support network filings in compliance with state and federal regulations.
(*) May include value-based agreements depending on market requirements.


(*) Accountable for cost arrangements and contract performance in support of network quality, availability and financial strategies to achieve P-Model, discounts and cost management goals.
(*) Ensures network coverage adequacy and implements action items to close gaps. Responsible for advancing the adoption of value-based payment models.
(*) May work with VBC Engagement managers to develop VBC arrangements and collaborative agreements.
(*) Develops and presents value proposition; presents the potential for network performance results in sales meetings or to external constituents.


(*) Analyzes data and is responsible for understanding medical cost issues and trends; collaborates with Medical Economics to monitor and identify score-able action plans; works closely with Population Health to enable and improve clinical outcomes.
(*) Will include oversight of the Provider Relations and Provider Data Systems teams that manage the service needs for providers including network/provider relations policy, recruitment, education and training, as well as improved workflows and provider data.
(*) Required to communicate w/internal/external parties by phone/in person; may require travel to offsite location.


Background Experience:

(*) 8 – 10 years related experience

(*) Related experience in health operations, network relations and development, command of financials and pricing strategies, and sales interface. Experience building and maintaining relationships with provider systems.

(*) A successful track record managing and negotiating major provider contracts. In depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers/providers.

(*) Knowledge and experience with value based contracting and accountable care models In-depth knowledge of managed care business, regulatory /legal requirements.

(*) Solid leadership skills, including staff development and talent management.

(*) Bachelor’s degree or equivalent work experience

(*) MBA/Master’s degree preferred
















Additional Job Information:

Provides daily oversight and leadership to
Provider Relations, Network Management, Contracting ,Claims,
Credentialing and Provider Data configuration and Provider Data Services teams.


Oversee the
development and delivery of regional support functions for local market network
operations


Manage
provider contract support functions including the
development of state filings; contract
support, review & approval; and other contract tracking


Ensure the maintenance and integrity of the
regional provider data base


Manage the development and delivery
of training programs for all aspects of network
management, provider contracting, provider service and provider operations and the newly formed Provider
Experience Management department.




Required Skills:
General Business - Maximizing Work Practices, Service - Managing Organizational Dynamics, Technology - Justifying the Business Case

Desired Skills:
Finance - Creating Profitable Partnerships, Finance - Servicing Customers Profitably, General Business - Communicating for Impact, General Business - Consulting for Solutions

Functional Skills:
Administration / Operation - Management: > 25 employees

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.

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