Overview
As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, belonging, integrity, quality and trust that are integral to our mission. EO/AA
This position is responsible for daily interaction with internal departments as well as conversations with the Provider Network. It requires frequent travel to Providers' offices where it negotiates contracts or letters of agreements, as well as deals with provider issues and concerns. This position writes draft contracts, amendments, letters of agreement, provider correspondence and other documents as necessary. It is responsible for financial performance within an assigned service area.
Corporate Overview: University of Utah Health is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University of Utah Health is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. University of Utah Hospitals and Clinics represents our clinical operations for the larger health system.
Responsibilities
Establishes professional and effective face-to-face, written, and telephone communication relationships with assigned providers.
Travels to provider and facility locations to identify, discuss, and resolve various issues, responds to provider requests for research and resolution of complaints.
Disseminates/communicates information to internal colleagues and communicates significant or important information to appropriate departments.
Interacts with Reimbursement Services regarding payment schedules and rates of reimbursement.
Performs initial orientation and ongoing in-service/education to providers.
Informs providers of policy changes and/or new policies.
Ensures providers are following proper medical procedure and referral, information/authorization, covered service guidelines, and submission of claims.
Assists in establishing financial and quality targets for medical expenses within the assigned service area and the ongoing monitoring and educating of providers who are not satisfying such targets.
Collaborates with assigned providers to close gaps in care and to improve member satisfaction.
Builds relationships of trust with providers through timely follow through and through a customer service focus.
Completes department initiatives that relate to assigned providers.
Initiates, coordinates, and negotiates contracts with physicians, hospitals, and ancillary in an assigned area to assure adequate medical services for Health Choice members. Maintains and ensures provider demographic information is complete and up to date.
Analyzes and evaluates network coverage to identify network needs.
Reviews contracts and proposals to determine proper reimbursement.
Obtains required information and documents from providers to begin the credentialing process.
Identifies and submits updates and corrections to demographics as they are identified or as received from the provider.
Analyzes network coverage to identify network needs.
Contracts and proposals are submitted to providers and reviewed. Acceptable reimbursement parameters are determined with management prior to execution of the contract.
Assists with applicable accreditation organization and regulatory compliance responsibilities.
Knowledge / Skills / Abilities
Strong organizational skills.
Strong presentation and oral and written communication skills.
Proficient ability to use Microsoft Office products include Excel and Word.
Ability to negotiate and implement provider contracts.
Strong customer service skills and techniques.
Ability to plan and organize.
Qualifications
Qualifications Required
Associate's degree or equivalency.
Two years experience in a health plan or health care environment.
Qualifications (Preferred)
Preferred
Experience with Medicare and/or Medicaid preferred.
Bachelor's degree in a business, finance or healthcare related field.
Working Conditions and Physical Demands
Employee must be able to meet the following requirements with or without an accommodation.
This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.
Physical Requirements
Carrying, Lifting, Listening, Manual Dexterity, Pulling and/or Pushing, Sitting, Speaking, Standing, Walking
Multi-lingual Candidates Welcomed
To inquire about this posting, email: careers@hsc.utah.edu
EEO Statement
University of Utah Health Hospitals and Clinics, a part of The University of Utah, values candidates who have experience working in settings with students and patients from all backgrounds and possess a strong commitment to improving access to higher education and quality healthcare for historically underrepresented students and patient populations.
All qualified individuals are encouraged to apply. Veterans' preference is extended to qualified applicants, upon request and consistent with University policy and Utah state law. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities.
University of Utah Health Hospitals and Clinics, a part of The University of Utah, is an Affirmative Action/Equal Opportunity employer and does not discriminate based upon race, ethnicity, color, religion, national origin, age, disability, sex, sexual orientation, gender, gender identity, gender expression, pregnancy, pregnancy-related conditions, genetic information, or protected veteran's status. The University does not discriminate on the basis of sex in the education program or activity that it operates, as required by Title IX and 34 CFR part 106. The requirement not to discriminate in education programs or activities extends to admission and employment. Inquiries about the application of Title IX and its regulations may be referred to the Title IX Coordinator, to the Department of Education, Office for Civil Rights, or both.
To request a reasonable accommodation for a disability, please contact the University of Utah Health Hospitals and Clinics Human Resources office at 801-581-6500. If you or someone you know has experienced discrimination or sexual misconduct including sexual harassment, you may contact the Director/Title IX Coordinator in the Office of Equal Opportunity (OEO). More information, including the Director/Title IX Coordinator's office address, electronic mail address, and telephone number can be located at:www.utah.edu/nondiscrimination/
Online reports may be submitted atoeo.utah.edu/
The University is a participating employer with Utah Retirement Systems ("URS"). Eligible new hires with prior URS service, may elect to enroll in URS if they make the election before they become eligible for retirement (usually the first day of work). Contact Hospitals and Clinics Human Resources at (801) 581-6500 for information. Individuals who previously retired and are receiving monthly retirement benefits from URS are subject to URS' post-retirement rules and restrictions. Please contact Utah Retirement Systems at (801) 366-7770 or (800) 695-4877 or Hospitals and Clinics Human Resources at (801) 581-6500 if you have questions regarding the post-retirement rules.
This position may require the successful completion of a criminal background check and/or drug screen.
Requisition Number 75521
Reg/Temp Regular
Employment Type Full-Time
Shift Day
Work Schedule M-F 8-5
Location Name University of Utah Health Plans
Workplace Set Up Remote
City Murray
State UT
Department UIP CST 01H Provider Services
Category Health Plans
Workplace Set Up Remote
