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 5 year(s)
Req'd Travel:
 Negligible
Relocation Covered:
 No
Reference ID:
27745013_306021231
 
  
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 Contract Negotiator (Home-Based in CT MA ME VT NH NJ RI    
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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.


POSITION SUMMARY
  • This position will provide network development, maintenance and refinement activities and strategies in support of AGHP TRICARE Network Management.
  • Accountable for all aspects of facility, non-facility and ancillary recruitment and contracting in assigned TRICARE Market(s).
  • Builds strong relationships with providers and key contacts to support on-going negotiation efforts
  • Responsible for negotiating facility, complex non-facility and ancillary provider contracts in support of network financial, in assigned areas; collaborates with other Aetna contracting areas (HCM, ABH, NNCS, AGB)
  • Provides support for AGHP credentialing and provider data management functions.
  • Understands medical cost drivers and executes specific network access and adequacy initiatives to support operational objectives
  • Partners across the organization to garner support for network contracting activities to ensure all aspects of operational implementation are completed on a timely and accurate basis
  • Conducts ad/hoc single case network negotiations, as assigned
  • May coordinate with AGHP market operational teams to address high profile provider issues raised by beneficiaries or the Government and identify provider educational opportunities.

    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.

    Position may be located in any of the following states: CT, MA, ME, VT, NH, NJ, RI, PA, NY


    • job Requirements

    EDUCATION
    Bachelor's degree or equivalent experience.

    FUNCTIONAL WORK EXPERIENCES
  • Network Management: Contract negotiation
  • Network Management: Provider relations
    REQUIRED SKILL/EXPERIENCE
  • Must possess a successful track record negotiating hospital, physician, or ancillary provider contracts
  • Collaboration experience across multiple functional areas
  • TRICARE or Military Health System experience preferred
  • Mastery of provider contracts, contracting options, PADU guidelines as well as provider configurations
  • In-depth knowledge of managed care business, regulatory /legal requirements, products, programs, strategy and objectives
  • Solid negotiating skills
  • Solid decision-making skills while executing national, regional, and market level strategies

    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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