Director of Network Management

Company: Aetna Inc.
Location: Harrisburg
Posted on: June 7, 2021

Job Description:

Job Description

Leads and manages teams of employees who develop, negotiate, contract, and enhance provider networks of high quality, are cost efficient and will improve healthcare for our customers. Oversees the development of programs to maintain and enhance collaborative provider relationships and operational effectiveness. Maintains accountability for related compliance, quality and financial goals. Manages a high functioning team responsible for

ensuring overall network competitiveness and profitability for a given geographical area or assigned provider type. The Director's responsibility and complexity may vary by market size and the need for units may be organized around services such as hospitals, providers, providers, or both the type of contract, such as fee for service or value based, compliance functions and or cost management efforts.

Required Qualifications

• Leads a team of Network Managers, Consultants and Contract Negotiators who design, develop, manage and/or implement strategic network configurations and effective managed care network relationships.
• Manages the activities of the network development team, including effective strategies to build progressive provider partners and relationships.
• Effectively negotiates the most complex, competitive contractual relationships with providers according to prescribed financial guidelines with all provider types including at risk, IPA/IPO, hospital and large provider/provider groups.
• Ensures necessary review oversee and support network filings in compliance with state and federal regulations.
• May include value-based agreements depending on market requirements.
• Accountable for cost arrangements and contract performance in support of network quality, availability and financial strategies to achieve P-Model, discounts and cost management goals.
• Ensures network coverage adequacy and implements action items to close gaps.
• Responsible for advancing the adoption of value-based payment models.
• Work with VBC Engagement managers to develop VBC

arrangements and collaborative agreements.

• Develops and presents value proposition presents the potential for network performance results in sales meetings or to external constituents.
• Analyzes data and is responsible for understanding medical cost issues and trends collaborates with Medical Economics to monitor and identify scorable action plans works closely with Population Health to enable and improve clinical outcomes.
• May oversee Network Relations teams that manage the service needs for providers including network/provider relations policy, recruitment, education and training, as well as improved workflows.
• Required to communicate w/internal/external parties by phone/in person may require travel to offsite location.

Preferred Qualifications

• 8 - 10 years related experience Related experience in health operations, network relations and development, command of financials and pricing strategies, and sales

interface.

• Experience building and maintaining relationships with provider systems
• A successful track record managing and negotiating major provider contracts
• In depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers/providers
• Knowledge and experience with value based contracting and accountable care models
• In-depth knowledge of managed care business, regulatory /legal requirements
• Solid leadership skills, including staff development and talent management

Education

Bachelors degree or equivalent work experience

MBA/Masters degree preferred

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., Harrisburg , Director of Network Management, Other , Harrisburg, Pennsylvania