Manager, Network Management (National Health Systems)
Core
Manages provider contracting, claims, and network development to ensure contract performance aligns with accessibility, compliance, quality, financial, and cost goals.
Role type
Manager, Provider Contracting & Network Management
Builds
Provider contracts, reimbursement models, and network strategies for Aetna/CVS Health
Domain
Health Insurance / Provider Relations
Required skills
Provider contracting, Claims management, Patient management, Contract negotiation, Dispute resolution, Cost analysis, Network development, Process improvement, Cross-functional collaboration, Team coaching
Preferred skills
Aetna systems (SCM, Smart Front End, Rate Inquiry, Contract Inquiry)
Technologies
ACAS, HRP, SCM, Smart Front End, Rate Inquiry, Contract Inquiry
Responsibilities
Construct and analyze provider contracts; deliver dispute resolution and settlement negotiations; forecast industry changes and develop modification strategies; integrate cross-functional collaboration for compensation and pricing development; manage cost issues and support cost-saving initiatives; assist in network development and refinement; coach junior colleagues.
Seniority
Manager, hands-on leadership