KS MCD Network Manager

Overland Park, KS
United States

Job Description
Design, develop, contract, maintain and enhance relationships with facilities, physicians and ancillary providers which serve as contractual networks of care for members; foster growth of managed care products; and enhance profitability of Aetna Medicaid. Negotiates, competitive and complex contractual relationships with providers according to pre-determined internal guidelines and financial standards. Works cross-functionally to execute network strategies. Maintains accountability for specific medical cost initiatives.

Fundamental Components:
Partner with health plan to determine network and contract needs. Effectively negotiates complex, competitive contractual relationships with providers according to prescribed guidelines in support of national and regional network strategies. Manages provider compensation/reimbursement and pricing development activities in partnership with health plan management. Responsible for reporting, understanding and managing medical cost issues and initiating appropriate action in partnership with health plan. Provides sales and marketing support, community relations and guidance with comprehension of applicable federal and state regulations. Assist and facilitate business intent reviews (BIR). Initiate legal reviews as needed; ensure all required reviews completed by appropriate functional areas. Regional owner of Strategic Contact Manager (SCM) and rate wizard.

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 arrangements and regulatory requirements.

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

Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/4-6 Years/End User

General Business/Demonstrating Business and Industry Acumen/ADVANCED
Sales/Managing Competitive Networks/MASTERY
Sales/Negotiating collaboratively/MASTERY

Benefits Management/Interacting with Medical Professionals/MASTERY
Leadership/Driving Strategic and Organizational Agility/ADVANCED
Technology/Selecting and Applying Technology Solutions/ADVANCED

Must possess a successful track record negotiating large hospital system contracts.Exceptional communication and negotiation skills required.Bachelor's degree. Masters degree preferred but not required. Comprehensive understanding of hospital and physician financial issues and how to leverage technology to achieve quality and cost improvements for both payers and providers. Computer proficiency and keyboard navigation skills; routine use of MS Office Suite, Outlook, Excel, Word, etc.

Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of Kansas is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of KanCare members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of Kansas, and we will support you all the way.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position.

Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.