Director of Network Management
Company: Aetna Inc.
Posted on: June 7, 2021
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
- 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
- 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
- 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
- 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
- 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
- Required to communicate w/internal/external parties by phone/in
person may require travel to offsite location.
- 8 - 10 years related experience Related experience in health
operations, network relations and development, command of
financials and pricing strategies, and sales
- Experience building and maintaining relationships with provider
- A successful track record managing and negotiating major
- In depth knowledge of various reimbursement structures and
payment methodologies for both hospitals and
- Knowledge and experience with value based contracting and
accountable care models
- In-depth knowledge of managed care business, regulatory /legal
- Solid leadership skills, including staff development and talent
Bachelors degree or equivalent work experience
MBA/Masters degree preferred
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
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