Thursday , May 30 2024

Aetna Remote Jobs – Network Manager

Website Aetna

Job Description:

This position assesses overall network composition and potential provider partners in order to identify and service partnerships that will advance and differentiate the Behavioral Health and EAP Network. This role negotiates, executes, and services contracts with local market providers in accordance with company standards to enhance provider networks and exceed accessibility, quality, and financial goals and cost initiatives.

Job Responsibilities:

  • Optimizes interaction with assigned providers and internal business partners to manage relationships to ensure provider needs are met.
  • Recruits providers and drives provider engagement as needed to ensure attainment of network expansion and adequacy targets.
  • Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
  • Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
  • Negotiates and executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with local market providers.
  • Provides network development, maintenance, and refinement activities and strategies in support of cross-market network management unit.
  • Manages contract performance and may support the development and implementation of value based contract relationships in support of business strategies.

Job Requirements:

  • Proven working knowledge of Behavioral Health provider operations, competitor strategies, financial/contracting arrangements, and regulatory requirements.
  • Bachelor’s Degree or equivalent combination of education and experience.
  • Strong communication, critical thinking, problem resolution and interpersonal skills.
  • Experience in designing and negotiating value based contracts and alternative payment models preferred.
  • 5-7 years related experience and comprehensive level of influencing skills with successful track record negotiating and servicing contracts with individual or complex provider systems or groups, preferably in Behavioral Health.

Job Details:

Company: Aetna

Vacancy Type:  Full Time

Job Location: Columbia, SC, US

Application Deadline: N/A

Apply Here