Job Overview
Company:
Location:
Base Pay:
 N/A
Other Pay:
Employee Type:
 Full-Time
Industry:
 Insurance
Manages Others:
 No
Job Type:
 Business Development
Health Care
Insurance
Req'd Education:
 4 Year Degree
Req'd Experience:
 At least 3 year(s)
Req'd Travel:
 Up to 25%
Relocation Covered:
 No
Reference ID:
27745013_306071243
 
  
Contact:
Not Available
Phone:
Not Available
Email:
Send Email Now
Fax:
Not Available
 

company overview

Aetna is one of the nation’s leading diversified health care benefits companies, serving members with information and resources to help them make better informed decisions about their health care.

Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life, long-term care and disability plans and medical management capabilities. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans and government-sponsored plans.

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Provider Network Account Manager (Home-Based in Massachusetts)    
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job description

ABOUT OUR COMPANY
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.


JOB GROUP SUMMARY
The Aetna Government Health Plans job family is designed to deliver and comply with Government program requirements offered to beneficiaries through the Department of Defense and the Department of Veteran's Affairs. This includes TRICARE and other related programs and services. The positions leverage Aetna's industry leading technology and customer focused competencies and skills to provide operational, quality, medical cost, and resource management programs that meet or exceed Government performance standards and expectations.

This is a home-based position and candidates need to reside in the Central Massachusetts.

POSITION SUMMARY
  • Responsible for developing and maintaining relationships with physician and business leadership of key physician groups, ancillary providers in TRICARE markets
  • Provides provider relations and services support (network and non network providers) for assigned geographic area(s); conduct provider group seminars and training sessions
  • Interacts with large, high profile physician groups, IPAs, PHOs and hospital systems to resolve disputes and find solutions that are mutually beneficial for both providers and the organization
  • Finalizes routine contracts and recruitment arrangements with providers in assigned areas; collaborates with Aetna contracting areas
  • Support AGHP credentialing and provider data management functions
  • Proactively identifies any provider dissatisfaction relative to AGHP TRICARE operations and works to raise awareness throughout the organization in order to gain consensus on a course of action and ultimately drive to implementation
  • Identifies opportunities for process improvement and works cross-functionally within the organization to gain desired outcomes regarding provider service issues
  • May coordinate with AGHP market operational teams to address high profile provider issues raised by beneficiaries or the Government and identify provider educational opportunities
  • Provides TRICARE Service Centers and Military Treatment Facilities local interactions on network adequacy and network development needs

    ADDITIONAL JOB INFORMATION
    As a government contractor, this position requires U.S. citizenship and proof of favorable results following submission of Department of Defense (DoD) form SF85P or higher security. You will be required to submit an application describing the previous seven (7) years of your life and to provide proof of U.S. citizenship. This process takes several months to complete. During this time, the DoD and Aetna Government Health Plans will grant interim access to U.S. citizens allowing you to work until your background investigation is completed. Adverse results will result in job termination.

    You will need reliable transportation to travel to provider sites within this area. Expected travel is 10-25%.

    Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.


    • job Requirements

    EDUCATION
    Bachelor's degree or equivalent experience

    FUNCTIONAL WORK EXPERIENCE
  • Network: Network development
  • Network: Provider relations

    REQUIRED SKILLS/EXPERIENCE
  • Demonstrated knowledge of managed care industry and provider relations activities
  • 2+ years related experience
  • Collaboration experience across multiple functional areas
  • TRICARE or Military Health System experience preferred
  • Working knowledge of provider business operations
  • Analytical/data-driven decision-making skills
  • Strong communication, critical thinking, interpersonal and negotiation skills

    We value leadership, creativity and initiative.  If you share those values and a commitment to excellence and innovation, consider a career with Aetna.

    We conduct pre-employment drug and background testing.
    Aetna does not permit the use of tobacco related products or drugs in the workplace. No agencies, please.
     
    Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V

    Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna's Affirmative Action responsibilities extend to women, minorities, persons with disabilities and veterans. Company policy also provides for equal opportunity for qualified individuals regardless of race, color, sex, national origin, religion, age, disability, veteran status, sexual orientation, gender identity or marital status.

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