Regional Director of Network ManagementPrimary Location: Woodland Hills, CA
Additional Locations: CA-Los Angeles, CA-Santa Ana, CA-Woodland Hills Apply
Builds and manages a high functioning team responsible for ensuring overall network competitiveness and profitability for given market or geographical area. Role may have responsibility for one or more markets, depending on business structure and required complexities.
66564Fundamental Components: Leads and helps to develop the overall network strategy for given area of responsibility (ie. defined geographic area) and drives teams to execution.
Leads the design, development, management, and/or implementation of strategic network configurations that drive membership growth.
Develops, directs and maintains relationships with external and internal care providers and their organizations.
Provides network strategy support to sales and marketing, along with assistance on community relations related items to achieve market and segment goals.
Oversees and/or negotiates the most complex, competitive contractual relationships with providers according to prescribed guidelines in support of enterprise and local strategies.
Overall accountability for contract negotiations involving all provider types including at-risk arrangements, IPA/PHO, hospital and large provider groups.
Provides a solid understanding and expertise in the End-to End aspects of provider contracting from modeling, configuration, utilization management, claims and analytics, including provider risk sharing.
Negotiate complex contract language and initiate legal reviews as needed; ensure all required reviews completed by appropriate functional areas.
Ensures network adequacy and implements actions to build out network expansion markets and/or to close gaps.
Advance the company strategy to adopt value based payment models; Coordinates with VBC network team and/or may directly lead teams to develop, negotiate and manage complex Value Based and Accountable Care (ACO) relationships.
May oversee the negotiation, implementation and management of VBC agreements.
Represents the organization at related external provider meetings and conferences.
May have responsibilities related to Joint Venture alliances.
Works closely with Population Health resources to enable and improve clinical outcomes.
Responsible for understanding medical cost issues and medical cost ratios (MLRs) and initiating appropriate action to manage improvement initiatives and scoreable action items.
Reviews analytics with medical economics and works with providers to develop collaborative initiatives that improve quality results, manage costs.
Background Experience: Preferred 10 or more years’ experience in managed care; leading and managing teams.
Comprehensive understanding of hospital and physician financial issues and how to leverage technology to achieve quality and cost improvements for both payers and providers.
In depth knowledge of various reimbursement structures and payment methodologies for both hospitals and physicians.
Comprehensive understanding of value based strategies and population health management, and Aetna’s related strategic initiatives.
Strong experience building and maintaining relationships with large hospitals/provider systems, integrated delivery systems and large physician groups.
May require knowledge of MACRA and other government programs (ex. Bundled payments) depending on market.
Solid leadership skills including staff development.
Understands the regulatory environment and ensures contractual compliance with federal and state requirements.
Bachelor's degree or equivalent work experience MBA/Master’s degree preferred. 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: General Business - Demonstrating Business and Industry Acumen, Leadership - Anticipating and Innovating, Leadership - Developing and Executing Strategy, Leadership - Driving Change Desired Skills: General Business - Maximizing Work Practices, General Business - Turning Data into Information, Leadership - Collaborating for Results, Leadership - Engaging and Developing People, Leadership - Fostering a Global Perspective Functional Skills: Network Management - Contract negotiation Technology Experience: Desktop Tool - TE Microsoft Excel Potential Telework Position: Yes Percent of Travel Required: 10 - 25% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by 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.
Jobs for you
Recently Viewed Jobs
You do not have any recently viewed jobs
Your Saved Jobs
You do not have any saved jobs
Sign up for Job Alerts
Join our Talent Community
At Aetna, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna.Sign Up
Join Our Talent Community
Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna.