Aetna Director, Network Management in Southfield, Michigan
Req ID: 53218BR
Negotiates, competitive and complex contractual relationships with providers according to pre-determined internal guidelines and financial standards. Works cross-functionally to execute network strategies. Maintains accountability for specific medical cost initiatives. Manages local network management team.
Negotiates and/or oversees negotiations with large hospital systems and complex physician organizations. 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. Initiate legal reviews as needed, ensure all required reviews completed by appropriate functional areas. Supervise day-to-day operations of network management team. Assist with the design, development, management, and/or implementation of strategic network configurations. Manages local Provider Relationship Management, Organization Orientation, and Provider Advocacy.
Must possess a successful track record negotiating large hospital system and complex physician group contracts.Maintains strong working relationships with internal constituents within the following areas: Medical Economics Unit, Contracts Coordination Unit, Provider Data Services, Sales, Patient Management, Legal and other areas within Aetna that are key to successful execution.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Network Management/Contract negotiation/7-10 Years
Functional - Network Management/Physician recruiting - medical/7-10 Years
Functional - Management/Management - Network Management/
Benefits Management/Interacting with Medical Professionals/MASTERY
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Leadership/Engaging and Developing People/ADVANCED
Leadership/Developing and Executing Strategy/ADVANCED
General Business/Turning Data into Information/MASTERY
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.
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 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.
Job Function: Health Care