Aetna 2 - Network Relations Cnslt - CA Health Plan (56264BR) in San Diego, California

Req ID: 56264BR

Aetna Better Health of California is hiring 2 Network Relations Consultant out of our San Diego Offices!

Acts as the primary resource claims and/or provider data analytics for high profile providers or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims, credentialing, medical management or compensation issues.

Fundamental Components:

  • Data Analytics related to provider data and/or claims

  • Solutions focused on provider data and/or claims

  • Communicate/translate plan needs data optimization and positive outcomes

BACKGROUND/EXPERIENCE desired:

-Highly organized with the ability to management multiple projects

-SQL Experience

EDUCATION

The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Managed Care/Managed Healthcare Professional is desired

Project Management/Six Sigma Trained is desired

FUNCTIONAL EXPERIENCES

Functional - Information Management/Business information analysis/4-6 Years

Functional - Management/Management - Data analysis and interpretation/4-6 Years

Functional - Network Management/Provider data services/1-3 Years

Functional - Project Management/Project Manager/1-3 Years

Functional - Claims/Claim processing - Medical or Hospital- HMO/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Database/SQL Server/4-6 Years/End User

Technical - Network/Provider data management/1-3 Years/End User

Technical - Database/Intuit QuickBase/1-3 Years/End User

Technical - Aetna Applications/QNXT/4-6 Years/End User

ADDITIONAL JOB INFORMATION

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 candidates'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.

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Job Function: Health Care

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.