Senior Manager, National Network Management (National Health Systems)
Core
Manage negotiation and development of contracts with large national or regional health systems (hospitals, physician groups, ancillaries) to support network strategies and cost initiatives.
Role type
Senior Manager, National Network Management (Contract Negotiation)
Builds
Provider networks and value-based contract relationships
Domain
Healthcare / Health Insurance / Contract Management
Required skills
Contract negotiation, cost management, dispute resolution, regulatory interpretation, strategic planning, cross-functional collaboration, provider relationship management, reimbursement modeling, claims payment resolution, network strategy formulation
Preferred skills
Value-based contracting, internal Aetna system knowledge, provider financial analysis, competitor strategy analysis, complex contracting options
Technologies
Aetna systems, NCQA standards
Responsibilities
Negotiate and execute contracts with complex health systems; conduct high-level review and analysis of contracts; manage cost issues and cross-functional cost saving initiatives; collaborate on provider compensation and pricing development; represent company with high visibility constituents; facilitate Joint Operations Committee (JOC) meetings; serve as SME for team members; resolve escalated issues regarding claims and contract interpretation; evaluate and implement national network strategic plans.
Seniority
Senior Manager, hands-on IC with strategic oversight