Senior Network Provider Manager, National Medicaid Ancillary Contracting

This is a fully remote position, open to applicants in Idaho, +1 more state.

📋 Description

• Negotiates, executes, and performs high-level reviews and analyses of dispute resolution and/or settlement negotiations of contracts with national providers.

• Recruits providers as necessary to achieve network expansion objectives.

• Assists the health plan with expansion initiatives or other contracting tasks as required.

• Initiates, coordinates, and oversees the fulfillment of contracting activities.

• Responsible for auditing, constructing, and uploading contracts, agreements, amendments, and/or fee schedules into contract management systems in accordance with Aetna’s established policies.

• Conducts research, analysis, and/or audits to identify problems and propose solutions.

• Manages contract performance and aids in the development and implementation of value-based contract relationships.

• Collaborates across functions to manage provider compensation and pricing development activities.

• Serves as a Subject Matter Expert regarding questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems, and information.

• Provides guidance and shares expertise with team members.

• Possesses an understanding of value-based contracting and negotiations.

• Manages high-level projects and recruitment initiatives with interdepartmental resources and/or cross-functional stakeholders.

• Supports or assists with operational tasks, which may include database management and contract coordination.

• Organizes and transforms information into understandable structures.

• Utilizes data to forecast trends in the customer base and the overall consumer population.

• Performs statistical analysis of data.

• Employs tools and techniques to visualize data in easy-to-understand formats, such as diagrams and graphs.

• Prepares reports and presents them to leadership.

• Engages with providers and facilitates their movement through the contracting processes.

⛳️ Requirements

• A minimum of 5 years of experience in network contracting/management.

• Willingness to travel as needed (up to 25% travel).

• 5 years of demonstrated knowledge of standard provider contracts, terms, and language.

• 5 years of strong negotiating and decision-making skills while implementing national, regional, or market-level strategies.

• Extensive knowledge of the managed care industry and practices, in addition to a robust understanding of competitor strategies, practices, and financial/contracting arrangements.

• Familiarity with ancillary contracting, including DME, Lab, Infusion, Home Health, Urgent Care, and Vendor services.

• Proven high proficiency with personal computers, including mouse, keyboard, and all MS Office suite applications (e.g., Outlook, Word, Excel, etc.).

• Knowledge of Medicaid programs.

• Strong decision-making abilities while executing national, regional, and market-level strategies.

• Capability to develop long-lasting relationships.

• Possesses critical thinking, problem-solving, and interpersonal skills.

• Ability to identify and leverage opportunities to enhance program delivery.

• Excellent communication skills (written, verbal, and presentation).

• Highly organized and self-motivated.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• CVS Health bonus.

• Commission or short-term incentive program.

• Equity award program.