Network Manager

Salary depends on experience
Posted on 11/08/17
Overland Park, KS
5 - 7 years experience
Managed Care & Health Insurance
Salary depends on experience
Posted on 11/08/17

POSITION SUMMARY

Negotiates, executes, conducts high level review and analysis, dispute resoltution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.

Fundamental Components:

Negotiates and executes, conducts high level review and analysis, dispute resoltution and/or settelement negotiations of contracts with larger and more complex, market-based, group/system providers. Manages contract performance and supports the development and implementation of value based contract relationships in support of business strategies. Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
Accountable for cost arrangements within defined groups. 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.
Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activities.
Serves as SME for less experienced team members and internal partners.
Provides network development, maintenance, and refinement activities and strategies in support of cross-market network management unit. Assists with the design, development, management, and or implementation of strategic network configurations and integration activities.
May optimize interaction with assigned providers and internal business partners to manage relationships to ensure provider needs are met. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information

BACKGROUND/EXPERIENCE desired:

  • Strong communication, critical thinking, problem resolution and interpersonal skills.
  • 5-7 years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with individual or complex provider systems or groups.
  • Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting

EDUCATION

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

FUNCTIONAL EXPERIENCES

Functional - Network Management/Contract negotiation/1-3 Years
Functional - Information Management/Analyzes all types of capitated and fee-for-service provider contracts, performs variance analysis/1-3 Years
Functional - Network Management/Network market leadership/1-3 Years
Functional - Network Management/Provider relations/4-6 Years
Functional - Network Management/Physician recruiting - medical/4-6 Years

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/Enterprise Provider Database System/4-6 Years/End User
Technical - Aetna Applications/Strategic Contracts Manager/1-3 Years/Power User
Technical - Desktop Tools/Microsoft Word/7-10 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User

REQUIRED SKILLS

Leadership/Developing and Executing Strategy/ADVANCED
Sales/Negotiating collaboratively/MASTERY

DESIRED SKILLS

Leadership/Driving a Culture of Compliance/ADVANCED

46625BR

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