Req ID: 18127BR
POSITION SUMMARY
Design, develop, contract, maintain and enhance relationships with facilities, physicians and ancillary providers which serve as contractual networks of care for members; foster growth of managed care products; and enhance profitability of Aetna
Fundamental Components:
o Responsible for developing and maintaining relationships with physician and business leadership of key physician groups, ancillary providers, and delivery systems
o Interacts with large, high profile physician groups, IPAs, PHOs and hospital systems to facilitate solutions that are mutually beneficial for both providers and the organization
Collaboration for Results
o Candidate must be familiar with the State of Rhode Island and the providers within the State of Rhode Island
o Collaborates cross-functionally on more complex issues to ensure provider needs are met and outstanding issues are resolved. i.e. provider service efficiencies, provider service improvement initiatives, identifies opportunities for process improvement.
o Collaborates with internal team members on the implementation of large, high profile physician groups, IPAs, PHOs and hospital systems to ensure a positive business relationship
BACKGROUND/EXPERIENCE desired:
Multi-functional experience
2-5 years industry experience. (Medical Cost Drivers and Managed Care Industry)
Working knowledge of provider business operations (PRL)
Analytical/data driven decision-making skills
Strong analytical, written/oral communication and presentation skills
Maintains professional working relationships with assigned provider types
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor''s degree or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Claims/Policies & procedures/4-6 Years
Functional - Communications/Provider communications/1-3 Years
Functional - Sales & Service/Sales administration, support, reporting/1-3 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Aetna Applications/Enterprise Provider Database System/1-3 Years/End User
REQUIRED SKILLS
Benefits Management/Interacting with Medical Professionals/ADVANCED
General Business/Demonstrating Business and Industry Acumen/FOUNDATION
General Business/Consulting for Solutions/ADVANCED
DESIRED SKILLS
Service/Providing Solutions to Constituent Needs/ADVANCED
Leadership/Developing and Executing Strategy/FOUNDATION
Leadership/Driving a Culture of Compliance/ADVANCED
Telework Specifications:
Full-Time Telework (WAH)
ADDITIONAL JOB INFORMATION
Good opportunity to focus on a market with a great deal of potential....This is also an opportunity to create, develop and grow relationships within the state of Rhode Island and internally within Aetna.
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.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Job Function: Health Care