Network Operations LeadPrimary Location: Walnut Creek, California
Additional Locations: CA-Walnut Creek Apply
This position is the network operations lead role. Manages all aspects of network operations in support of Network/ Cost Leader and Market Presidents and acts as coordination point across all business partners; key internal role responsible for maintaining network operations, supporting various activities associates with network filings, network compliance and dispute resolution/ litigation.
- Partner across the organization to support network development, maintenance, refinement activities, regulatory filings, migration and rate activities
- Specific focus and priorities of role will be at the discretion of the Market President and Network/ Cost Leader as dictated by unique market environment and needs
- 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 (e.g., surprise bill); supports Network/Cost Leader and Market President, in partnership with Legal, in managing litigation (e.g., panels, hearings, depositions, arbitration, court appearances)
- Responsible for understanding policy changes and assessing how changes impact network strategy, as well as state and Medicare regulatory compliance; prepares and submits required state and CMS filings
- May manage team of local market network operations resources as applicable
- Partners closely with National Network functions including Provider Operations and Data Services
Background/ Experience Desired:
- Deep knowledge of health care industry, policy, research design
- Advanced technical, analytic and consultative skills, extensive knowledge of health care data and information systems, as well as an understanding of 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 negotiation and influencing sound business decisions based on data, results and information derived from industry trends, research findings, and Aetna-specific reports and analyses
- Builds and maintains positive, productive relationships with internal and external constituents at the most senior and regulatory 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
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Network Management/Contract negotiation/1-3 Years
Functional - Network Management/Provider data services/1-3 Years
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Leadership/Creating a World Class Workforce/ADVANCED
Leadership/Driving Strategic and Organizational Agility/ADVANCED
Flexible telework / office-based schedule (must live in CA)
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. 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.
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.
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.
58062Potential Telework Position: Yes Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer
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