Manager, Network Management (National Health Systems)

Constructs negotiation, execution, review, and analysis of contracts. Delivers dispute resolution and settlement negotiations with providers. Ensures contract performance aligns with accessibility, compliance, quality, financial, and cost goals. 

• Develop, maintain, and enhance working relationships with physicians/providers and local network and patient management teams in the markets with Aetna.

• Establishes and implements programs and innovative initiatives for the organization to advance Contract Negotiations initiatives.

• Forecasts changes within the Contract Negotiations industry, conducts business impact assessments, and develops modification strategies with the aid of process improvement methodologies. 

• ntegrates cross-functional collaboration to contribute to provider compensation and pricing development activities and recommendations for negotiations and reimbursement modeling activities. 

• Determines recommendations to manage cost issues and support cost-saving initiatives and settlement activities. 

• Assists in the management of network development, maintenance, and refinement activities and strategies in support of cross-market network management units. 

• Coaches more junior colleagues in techniques, processes, and responsibilities. 

• Other duties and responsibilities as assigned by manager. 

 
Required Qualifications 

• 5+ years of provider contracting, claims management, or patient management experience.

• 5+ experience working with/or in a Claims environment 

• 5+ experience that includes ACAS and HRP claim platforms, products, and benefits; patient management, provider relations, or claims management. 

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Preferred Qualification 

• Experience with Aetna systems (SCM, Smart Front End, Rate Inquiry, Contract Inquiry) 

 
Education 

• Bachelor's degree preferred or a combination of professional work experience and education.