2 - Network Relations Cnslt - CA Health Plan (56264BR)
6113 Camino Maquiladora
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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. #LI-MR1 56264
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.