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Job Title: Provider Network Acct Mgr (Home-Based in DE)
Job Group: Health Care
Requisition #: 27386
Location: Dover, DE
Secondary Location: Newark, DE
Travel: 10 - 25%
Potential Telework Opportunity: Yes
FLSA Status: Exempt
Full/Part Time: Full Time
Pay Opportunity: $43,560.00 - $53,300.00
Bonus Potential: 10%
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.
JOB GROUP SUMMARY
The Aetna Government Health Plans job family is designed to deliver and comply with Government program requirements offered to beneficiaries through the Department of Defense and the Department of Veteran's Affairs. This includes TRICARE and other related programs and services. The positions leverage Aetna's industry leading technology and customer focused competencies and skills to provide operational, quality, medical cost, and resource management programs that meet or exceed Government performance standards and expectations.
Bachelor's degree or equivalent experience
FUNCTIONAL WORK EXPERIENCE
- Network: Network development
- Network: Provider relations
This is a home-based position and candidates need to reside in or with easy access to the whole state of Delaware
- Responsible for developing and maintaining relationships with physician and business leadership of key physician groups, ancillary providers in TRICARE markets
- Provides provider relations and services support (network and non network providers) for assigned geographic area(s); conduct provider group seminars and training sessions
- Interacts with large, high profile physician groups, IPAs, PHOs and hospital systems to resolve disputes and find solutions that are mutually beneficial for both providers and the organization
- Finalizes routine contracts and recruitment arrangements with providers in assigned areas; collaborates with Aetna contracting areas
- Support AGHP credentialing and provider data management functions
- Proactively identifies any provider dissatisfaction relative to AGHP TRICARE operations and works to raise awareness throughout the organization in order to gain consensus on a course of action and ultimately drive to implementation
- Identifies opportunities for process improvement and works cross-functionally within the organization to gain desired outcomes regarding provider service issues
- May coordinate with AGHP market operational teams to address high profile provider issues raised by beneficiaries or the Government and identify provider educational opportunities
- Provides TRICARE Service Centers and Military Treatment Facilities local interactions on network adequacy and network development needs
- Demonstrated knowledge of managed care industry and provider relations activities
- 2+ years related experience
- Collaboration experience across multiple functional areas
- TRICARE or Military Health System experience preferred
- Working knowledge of provider business operations
- Analytical/data-driven decision-making skills
- Strong communication, critical thinking, interpersonal and negotiation skills
ADDITIONAL JOB INFORMATION
NOTE: This position is contingent based on award of TRICARE contract.
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.
This is a home-based position and candidates need to reside in or near Delaware. You will need reliable transportation to travel to provider sites within Delaware. Expected travel is 10-25%.
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.
Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.
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