Network Manager

About Our Company
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.

JOB MISSION SUMMARY

The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge.

RESPONSIBILITIES
- Evaluates current contracts, renegotiates where applicable, and applies managed care reimbursement principles (capitation, per diems, creative reimbursement, etc.) to maximize cost savings, while maintaining high quality and access standards
- Researches current and new contract operational procedures, coordinates with appropriate departments, to streamline processes wherever possible
- Models best practices in contracting to other contracting specialists
- Oversees initial and ongoing cost/benefit analysis of contracts to determine cost effectiveness, renegotiating as appropriate
- Ensures that major contracts are paying according to agreed-upon terms on a regular basis
- Researches and prepares RFP's and letters of interest, analyzing results and making recommendations to Director of Network Development and Contracting
- Coordinates implementation of new contracts with departments involved
- Coordinates internal review and determine/evaluate administrative feasibility throughout the continuum of the contracting process
- Serves as an internal resource to Mercy Care Plan (MCP) departments regarding managed care and contractual issues as they arise, and participates in various Committee meetings
- Ensures 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
- Drafts and negotiates Letters of Agreements as requested by Medical Management Departments obtaining appropriate legal and management review and approval
- Negotiates and amends contracts as required per updated new state regulatory mandates
- Completes system configuration requests for all provider network changes and modifications; and ensures compliance with state regulatory technical requirements for reporting and encounter submission
- Responds to provider correspondence and telephone inquires
- Recruits new providers
- Assigned key provider accounts including hospitals and large physician groups



Required Skills:
REQUIRED SKILLS
- Bachelors degree in business, health care management or related field. Significant additional experience may be considered in lieu of a Bachelors degree, at the discretion of the hiring manager
- Must have a minimum of seven years professional-level healthcare contracting experience
- Must have a minimum of ten years in a managed health care environment
- Demonstrated experience with large provider organizations, ancillary and hospital providers, common coding, and billing requirements is required

ADDITIONAL JOB INFORMATION
- Skills in contract negotiation and relations, and effective problem-solving abilities
- The ability to read, comprehend, and negotiate contracts and services at an effective level; the ability to communicate effectively, write correspondence, procedures and policies, and supporting documentation
- The ability to present information effectively in one-on-one and small group settings to providers and employees
- The ability to use effective reason to define problems, collect data, establish fact, draw valid conclusions, and design, implement, and manage appropriate action plans
- Experience with QMACS/QNXT is helpful


Schaller Anderson is an affiliate of Aetna.  We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.

To learn more about this opportunity, visit us at www.aetna.com/working 22808

Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.

We conduct pre-employment drug and background testing.
No agencies, please.


We are an equal opportunity/affirmative action employer.