Manager – Network Management

Constructs negotiation, execution, review, and analysis of contracts. Delivers dispute resolution and settlement negotiations with providers. Ensures contract performance aligns with accessibility, compliance, quality, financial, and cost goals. 

• Develop, maintain, and enhance working relationships with physicians/providers and local network and patient management teams in the markets with Aetna.

• Establishes and implements programs and innovative initiatives for the organization to advance Contract Negotiations initiatives.

• Forecasts changes within the Contract Negotiations industry, conducts business impact assessments, and develops modification strategies with the aid of process improvement methodologies. 

• ntegrates cross-functional collaboration to contribute to provider compensation and pricing development activities and recommendations for negotiations and reimbursement modeling activities. 

• Determines recommendations to manage cost issues and support cost-saving initiatives and settlement activities. 

• Assists in the management of network development, maintenance, and refinement activities and strategies in support of cross-market network management units. 

• Coaches more junior colleagues in techniques, processes, and responsibilities. 

• Other duties and responsibilities as assigned by manager. 

 
Required Qualifications 

• 5+ years of provider contracting, claims management, or patient management experience.

• 5+ experience working with/or in a Claims environment 

• 5+ experience that includes ACAS and HRP claim platforms, products, and benefits; patient management, provider relations, or claims management. 

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Preferred Qualification 

• Experience with Aetna systems (SCM, Smart Front End, Rate Inquiry, Contract Inquiry) 

 
Education 

• Bachelor's degree preferred or a combination of professional work experience and education.