Provider Contract NegotiatorAetna Inc. - Phoenix, AZ
Negotiates, re-negotiates and executes physician and/or provider contracts in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals.
Accountable for all aspects of physician recruitment and contracting as well as ad/hoc network contracting, as assigned (*) Responsible for re-negotiating or negotiating solo, complex group, hospital-based and large entity physician contracts in support of network quality, availability and financial goals (*) Participates in the strategic recruitment of physicians satisfying specific network goals and objectives (*) Provides network development, maintenance and refinement activities and strategies in support of cross-market network management units (*) 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
Must possess contract negotiation skills to contract provider types: Behavioral Health RBHA, SNF, Home Community Base Services, Ancillary/DME, Physicians and Dentist. Understanding of contract management, compliance, and credentialing. Able to communicate with all levels of management: C-Suites, VP level and Director/ Manager levels. Knowledge of all AZ Medicaid (AHCCCS) programs.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Network Management/Contract negotiation/1-3 Years
Functional - Network Management/Physician recruiting - medical/1-3 Years
Functional - Network Management/Provider relations/1-3 Years
Functional - Network Management/Credentialing/1-3 Years
Functional - Network Management/Provider data services/1-3 Years
Technical - Network/Provider contract management/1-3 Years/Administrator
Technical - Network/Network management/1-3 Years/Administrator
Technical - Network/Provider credentialing/1-3 Years/Administrator
Technical - Network/Provider data management/1-3 Years/Administrator
Leadership/Driving a Culture of Compliance/ADVANCED
Sales/Managing Competitive Networks/ADVANCED
Benefits Management/Interacting with Medical Professionals/ADVANCED
General Business/Consulting for Solutions/ADVANCED
ADDITIONAL JOB INFORMATION
Mercy Care Plan is a not-for-profit health plan serving AHCCCS members (Medicaid acute, DDD and long-term care). Mercy Care Advantage is a health plan for people with special needs who qualify for AHCCCS and Medicare. We have been a part of the Arizona community since 1985.
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
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.
Benefit eligibility may vary by position. Click here
to review the benefits associated with this position.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
13 days 18 hours ago
applyProvider Contract Negotiator Aetna Inc. - Phoenix, AZ, United States
Aetna Inc. operates as a diversified health care benefits company in the United States. The company operates in three segments: Health Care, Group Insurance, and Large Case Pensions. The Health Care segment provides medical, pharmacy benefit management, dental, behavioral health, and vision plans on an insured basis, and an employer-funded or administrative basis. This segment also provides Medicare and Medicaid products and services, as well as other medical products, such as medical management and data analytics services, medical stop loss insurance, workers' compensation administrative services, and products that provide access to its provider networks in select markets. This segment offers its products and services to multi-site national, mid-sized, and small employers, as well as individual customers. The Group Insurance segment provides life insurance products comprising group term life insurance, voluntary spouse and dependent term life insurance, group universal life, and accidental death and dismemberment insurance; disability insurance products; and long-term care insurance products, which offer benefits to cover the cost of care in private home settings, adult day care, assisted living, or nursing facilities. This segment provides insurance products principally to employers that sponsor its products for the benefit of their employees and their employees dependents. The Large Case Pensions segment manages various retirement products, including pension and annuity products for tax-qualified pension plans. The companys customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups, and expatriates. Aetna Inc. was founded in 1853 and is headquartered in Hartford, Connecticut.
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