Senior Manager, Network Management – Keystone Market

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Negotiate, execute, and evaluate intricate provider contracts, including dispute resolution and settlement discussions.

• Oversee contract performance and facilitate value-based arrangements that align with business objectives.

• Propel network growth and adequacy through provider recruitment and focused strategies.

• Responsible for cost arrangements and ensuring contracts align with financial targets.

• Collaborate across departments on pricing, compensation, and reimbursement modeling efforts.

• Perform contract analysis to uncover cost savings and optimization possibilities.

• Address escalated issues such as claims, contract interpretation, and provider data accuracy.

• Ensure adherence to regulatory requirements and company standards.

• Act as a subject matter expert and offer guidance to team members.

• Assist with network development and strategic configuration projects.

⛳️ Requirements

• 7–10 years of experience in healthcare contracting or network management.

• Strong knowledge of provider financials and reimbursement methodologies.

• Demonstrated negotiation, communication, and cross-functional collaboration abilities.

• Familiarity with the Keystone market is preferred.

• Experience with Aetna internal systems is preferred.

• Advanced proficiency in Microsoft Office applications.

• Background in value-based care agreements.

• Experience across Commercial, Medicare, and Medicaid lines of business.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Other resources, based on eligibility.