Senior Network Provider Manager, National Medicaid Ancillary Contracting Remote

Position Summary

The Medicaid Senior Manager, Network Management:
Negotiates, executes, conducts high level review and analysis of dispute resolution and/or settlement negotiations of contracts with national providers including, but not limited to labs, Home Health, Home Infusion, Dialysis Centers, Transportation and Vision vendors, in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives. Recruit providers as needed to ensure attainment of network expansion goals, achieve regulatory and/or internal adequacy targets.

Support health plan with expansion initiatives or other contracting activities as needed. Initiates, coordinates and owns the contracting activities to fulfillment including receipt and processing of contracts and documentation and pre- and post-signature review of contracts and language modification according to Aetna’s established policies. Responsible for auditing, building, and loading contracts, agreements, amendments and/or fee schedules in contract management systems per Aetna’s established policies.

Conducts research, analysis and/or audits to identify issues and propose solutions to protect data, contract integrity and performance. Manages contract performance and supports the development and implementation of value-based contract relationships in support of business strategies. Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.

Provides Subject Matter Expert support for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained. Provide guidance and share expertise to others on the team. Understanding of Value Based contracting and negotiations. Manage high level projects and recruitment initiatives with interdepartmental resources and/or cross functional stakeholders. May participate in JOC meetings. Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination.

Organizing and transforming information into comprehensible structures. Using data to predict trends in the customer base and the consumer population as a whole. Performing statistical analysis of data. Using tools and techniques to visualize data in easy-to-understand formats, such as diagrams and graphs. Preparing reports and presenting these to leadership. Engage with providers and quickly move the providers through contracting processes in order to ensure meeting network adequacy requirements.

This position can sit anywhere in the United States.

• Negotiate, execute, conduct high‑level review and analysis of dispute resolution and/or settlement negotiations of contracts with national providers.
• Recruit providers to meet network expansion goals and regulatory adequacy targets.
• Support health plan expansion initiatives and contracting activities.
• Initiate, coordinate and own contracting activities through fulfillment.
• Audit, build and load contracts, agreements, amendments, and fee schedules into contract management systems.
• Conduct research, analysis, and audits to identify issues and propose solutions.
• Manage contract performance and support value‑based contract relationships.
• Collaborate cross‑functionally on provider compensation, pricing development, contractual data submission, and reimbursement modeling.
• Provide subject‑matter‑expert support on recruitment, contracting, and related systems.
• Guide and mentor team members.
• Manage high‑level projects and recruitment initiatives with cross‑functional stakeholders.
• Participate in JOC meetings as needed.
• Assist with operational activities including database management and contract coordination.
• Organize and transform data into comprehensible structures.
• Use data to predict trends and perform statistical analysis.
• Create visualizations such as diagrams and graphs.
• Prepare reports and present to leadership.
• Engage…