Mgr – Contract Negotiation

Mgr – Contract Negotiation

Requirements

• 3-5 years of network contracting/management experience.
• 3-5 years of solid negotiating and complex decision-making skills while executing national, regional, or market level strategies.
• In-depth knowledge of the managed care industry and practices.
• Working knowledge of behavioral health topics related to managed care plans.
• Detail-oriented with strong communication, analytical and negotiation skills.
• Demonstrated high proficiency with MS Office suite applications (e.g., Outlook, Word, Excel, etc.).
• Ability to build collaborative relationships with providers work cross-functionally to resolve complex provider contract issues.
• Ability to work remotely, preferably in DE, PA, NH, and RI. Candidates in other east coast states will also be considered.

Responsibilities

• Negotiates, executes, conducts high level review and analysis of dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers including but not limited to individual and group behavioral health providers, etc. in accordance with company standards in order 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 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 established policies.
• 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 Expertise for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained.
• Understanding of Value-Based contracting and negotiations.
• Preparing reports and presenting to Network Management leadership.
• Engage with providers and move quickly through contracting processes to ensure network adequacy standards are met.

Preferred Qualifications

• Health plan experience supporting behavioral health provider networks.
• General knowledge of reporting tools for contract financial analysis and modeling.
• Solid decision-making skills while executing national, regional and market level strategies.
• Possess critical thinking, issue resolution and interpersonal skills.
• Strong communication skills (written, verbal and presentation).
• Highly organized and self-driven.