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Network Manager

Company: Aetna Inc.
Location: Wilmington
Posted on: January 15, 2022

Job Description:

Job Description

Negotiates, executes, conducts high level review and

analysis, dispute resolution 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.

Required Qualifications

* Negotiates and executes, conducts high level review

and analysis, dispute resolution and/or settlement

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.

* 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 info.

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

* If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
* If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

* Proven working knowledge of provider financial

issues and competitor strategies, complex

contracting options, financial/contracting arrangements

and regulatory requirements.

* 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.

* Strong communication, critical thinking, problem

resolution and interpersonal skills.

Education

Bachelor's Degree or equivalent combination of

education and experience.

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Keywords: Aetna Inc., Wilmington , Network Manager, Executive , Wilmington, Delaware

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