Requisition number: 2351604
Job category: Network Management
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
So where are we today? The public and health care community are focused on the scope, diversity and quality of provider networks associated with health care products and coverage. People like you and organizations like UnitedHealth Group are driving ever higher levels of sophistication in how provider networks are composed and compensated. That means everything is open to new ideas and innovation. And your expertise in provider networks can help us build in the next phase of evolution. In this managerial role, you'll use your knowledge and analytical skills to help determine how clinical providers group up by specialty and service line. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 5 leader.
You'll enjoy the flexibility to work remotely * on the West Coast as you take on some tough challenges.
Primary Responsibilities:
Provides leadership to and is accountable for the performance of managers and/or senior level professional staff
Impact of work is most often at the operational or local business unit or market level
Owns an end-to-end process
Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities
Identifies and resolves technical, operational and organizational problems outside own team
Develops innovative approaches
Serves as key resource on complex/critical issues
Lead functional or segment teams or projects
Tactical Responsibilities:
West Region Direct Payer Network Point of Contact
Project Manage Provider Bulletins that impact provider networks
Liaison between Pricing Integrity, Contracting, Onboarding and Provider Relations ensuring "pay as the state pays" alignment with MassHealth regulations
Liaison between provider network and Account Management team
Ensure Network Reporting set up and maintenance
Support benefit expansion initiatives
Support network quality improvement initiatives
Provider network readiness review
Monitor performance guarantees
Monitor emerging trends coming from provider-facing teams. Implement corrective action plans
Establish and maintain Network policies and procedures to comply with regulatory and contractual requirements impacting provider network
Regulatory and Customer audit - provider network deliverables
QBR participant
Oversee trade org relationships
This is an opportunity that will offer you challenge like no other. We operate a complex, matrixed business that requires you to work through ambiguity even as you build a relationship with some of our most focused and intense business leaders. You'll need to conceptualize effectively, communicate clearly and earn credibility within a demanding business environment.
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
5+ years of provider relations experience
5+ years of supervisory level experience in a network management-related role handling complex network providers with accountability for business results
3+ years of experience with Medicare and Medicaid regulations
Ability to call on Providers
Intermediate level of knowledge of claims processing
Demonstrated exceptional presentation, written and verbal communication skills
Demonstrated proficiency in MS Word, PowerPoint, Excel, and Access
Ability to travel up to 50%
Driver's license and access to reliable transportation
Dedicated, distraction-free workspace and access to high speed internet in home
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 to $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
