Aetna Senior Provider Relations Representative - CA Medicaid (52723BR) in San Diego, California

Req ID: 52723BR

Aetna Better Health of CA is hiring a Senior Delegation Provider Relations Oversight Representative in San Diego

Our Senior Delegation Oversight Representative will act as the primary resource for assigned, 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, and provider education needs.

Telework Specifications:

(*) Flexible telework / office-base schedule (must live near certain office location)

(*) Option for flexible telework will be evaluated after a certain period of employment


(*) Highly organized with the ability to management multiple projects

(*) 3+ years experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation

(*) Medi-Cal experience will be preferred in addition to healthcare experience

(*) Manage elements of delegation oversight in collaboration with functional areas.

(*) Delegation Oversight, Credentialing, Claims, Medical Management, Project Management, Joint Operations Meeting, Meeting Facilitation


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


Managed Care/Managed Healthcare Professional is desired


Functional - Management/Management - Provider Data/1-3 Years

Functional - Network Management/Provider relations/4-6 Years

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

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


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.


Job Function: Health Care