Aetna Network Manager in Augusta, Maine

Req ID: 43833BR

POSITION SUMMARY

This position is a technically advanced position in the field of healthcare contracting on the payer side. This position is responsible for all contractual and rate negotiations with large Independent Physician Offices, Hospital Facilities and Hospital Systems, while maintaining exceptional provider relationships.

Fundamental Components:

  • Effectively negotiates complex, competitive contractual relationships with providers according to prescribed guidelines

  • In support of national and regional network strategies (*)

  • Manages provider compensation/reimbursement and pricing development activities (*)

  • Responsible for understanding and managing medical cost issues and initiating appropriate action (*) Provides sales

    and marketing support, community relations and guidance with comprehension of applicable federal and state regulations

  • Assist and facilitate business intent reviews (BIR) (*)

  • Initiate legal reviews as needed; ensure all required reviews completed by appropriate functional areas(*)

  • Regional owner of Strategic Contact Manager (SCM) and rate wizard (*)

    BACKGROUND/EXPERIENCE desired:

    Must possess a successful, 5-7 year, track record negotiating large IPA and hospital system contracts

    Bachelor's Degree Required

    Excel experience

    Knowledge and use in data and reporting systems

    Excellent Professional Presentation Skills

    EDUCATION

    The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

    LICENSES AND CERTIFICATIONS

    Healthcare Management/ is desired

    Leadership/ is desired

    Communications/ is desired

    Project Management/ is desired

    FUNCTIONAL EXPERIENCES

    Functional - Network Management//4-6 Years

    Functional - Customer Service//7-10 Years

    Functional - Project Management//4-6 Years

    Functional - Information Management//1-3 Years

    Functional - Legal//1-3 Years

    TECHNOLOGY EXPERIENCES

    Technical - Aetna Applications/Strategic Contracts Manager/1-3 Years/

    Technical - Database//1-3 Years/

    Technical - Network/Network management/4-6 Years/

    REQUIRED SKILLS

    Service/Creating a Differentiated Service Experience/ADVANCED

    Sales/Managing Competitive Networks/MASTERY

    Leadership/Driving a Culture of Compliance/ADVANCED

    DESIRED SKILLS

    Technology/Selecting and Applying Technology Solutions/ADVANCED

    Leadership/Developing and Executing Strategy/ADVANCED

    Telework Specifications:

    Flexible telework / office-based schedule - must be within commuting distance to the South Portland, Maine office.

    ADDITIONAL JOB INFORMATION

    Looking for a candidate who wants to join a fast pace, successful and engaging healthcare team to continue to develop and grow our existing outstanding provider relationships. Looking for a candidate who is committed to improving healthcare for all our members through collaboration with our Provider Partners.

    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.

    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.

    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.

    Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

    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.

Job Function: Health Care