Network Manager

Company Name:
Req ID: 16895BR
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 the necessary steps to ensure that contracts are loaded into systems accurately and timely and manages implementation of new contracts with departments involved. - 5 years (at a minimum) of provider contracting experience - Experience with medicaid contracting strongly preferred Can be located in Atlanta, GA or CT-possible work from home
The highest level of education desired for candidates in this position is a Bachelor''s degree or equivalent experience.
Service/Demonstrating Service Discipline/ADVANCED
General Business/Turning Data into Information/ADVANCED
Service/Creating a Differentiated Service Experience/ADVANCED
Sales/Negotiating collaboratively/MASTERY
Technology/Selecting and Applying Technology Solutions/ADVANCED
Leadership/Developing and Executing Strategy/ADVANCED
Required Skills:- Load final negotiated contracts into appropriate systems (Mastery)- Analyze and refine provider networks to assure appropriate network composition (Foundation)- Negotiate and manage network contractual arrangements (Mastery)- Negotiate contracts and other understandings on behalf of the company (Mastery)- Utilize PADU guidelines for negotiations (Mastery)- Manage requests for special contractual language (Mastery)- Participates in organizational audits to ensure organizational compliance with regulatory agencies as appropriate.- Evaluates current contracts, renegotiates where applicable, and applies managed care reimbursement principles (capitation, per diems, creative reimbursement, etc.) to maximize cost savings- Manages and develops the skills of department personnel. - Develops and maintains the Health Plan contract templates, including securing all required approvals. - Manages initial and ongoing cost/benefit analysis of contracts to determine cost effectiveness, renegotiating as appropriate. - Manages the process of appropriate legal / regulatory review of contracts prior to execution. - Drafts, recommends and writes both standard and specialized contracts, ensuring that all required components are included.- Ensures networks adequacy and cost effectiveness in accordance with established minimum standards.
Please note that benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Aetna does not permit the use of tobacco related products or drugs in the workplace.
Job Function:

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