Lead Director, Network Management (Southern California)
Core
Developing strategic partnerships to ensure market-leading discount and cost positions for Aetna's provider networks.
Role type
Lead Director, Network Management
Builds
Provider networks for Aetna
Domain
Health insurance / Provider contracting
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
expert level negotiation, financial analysis, pricing strategy, contract management, network expansion, regulatory compliance, cross-functional collaboration
Preferred skills
FFS/Value Based/Capitation contracting, Southern California market experience, Aetna systems proficiency, ancillary provider management
Technologies
Strategic Contract Manager, EPDB, Quickbase, Claims Systems-HRP-ACAS
Responsibilities
Negotiate high-value contracts with complex providers, lead negotiation teams for health systems and hospitals, recruit providers to meet network targets, manage provider compensation and pricing, execute cost-saving initiatives, resolve escalated claims and contract issues
Seniority
Senior, strategic leadership
