Associate Director, Network Programs, Warwick, RI Job in Warwick 02886, Rhode Island US
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
What makes your Network career greater with UnitedHealth Group? Growth opportunities among the variety of product lines and making an impact on the healthcare system ensures it will always be challenging and exciting. This Community and State Network Strategy Lead is responsible for oversight of the provider network (i.e., to ensure that the Plan has a network which meets regulatory requirements), for oversight of the Provider Advocacy program, and for the development and implementation of programs designed to engage those providers for purposes of achieving the Plan's stated objectives. S/he is the primary liaison with Corporate on all issues related to network programs and provider relations, including but not limited to:
-Assists in relationship building and management of key providers; participates in Provider Advisory Council meetings
- Engages in Provider relations strategy meetings; educates Provider relations team members on C S products, reimbursement policies and regulatory requirements;
- Delivers in-service training for provider advocacy team to ensure thorough understanding of programs, goals and objectives; ensures that required reports for provider advocates to deliver to providers are available;
- Attends meetings and training's related to new UnitedHealthcare and CS products and lines of business; facilitates training programs and delivers high quality educational information
- Ensures information is communicated downstream to enable network partners to deliver appropriate CS messages to providers; oversees provider newsletter; ensures all required education and information is communicated;
- Drafts correspondence to providers related to changes, new policies, programs, products, etc.
- Oversees provider related issues resolution as needed working with State of RI Medicaid or Department Of Health (DOH) ;
- Ensures compliant policies and procedures
- Oversees any Corrective Action Plan (CAP) reviews and ensures communication with providers
- Collaborates with the health plan's Quality Lead, CMO and OPTUM Health team to develop programs that improve quality outcomes
- Collaborates with the health plan's Marketing Lead to identify targeted communities and goals for positive membership growth
- Collaborate with sister segments to identify and develop culturally appropriate materials for providers;
- Works in partnership with UHN on the annual Purchase Order; collaborates to identify appropriate hospital and ancillary providers
- Develops and reviews payment methodologies that align with the health plan's goals and objectives;
- Reviews fee schedule increase requests/justification and with Director, determine which go to Finance for impact analysis; Conduct final review and make determinations about fee increases to key providers;
- Review payment methodologies/fee schedules and make recommendations for change to better align with goals and objectives
- Develops policies and procedures related to Network and Provider Relations activities for the health plan
- Oversees the development, compliance and maintenance of the Provider Manual
- Participates in Tier 1 hospital Joint Operating Committees
- Works together to conduct joint delegate oversight activities of Network Operations
- In conjunction with Quality Lead, oversee vendors whose networks are utilized by the Plan
- Conducts delegated oversight of provider relations
- Hosts or attends forums designed to create engagement and partnership at all levels of health care delivery and promote the notion of the MCO as a key player in ACOs
- This position is office based out of the Warwick, RI location on Kilvert Street
Requirements:
- 5+ years experience working with a managed care organization, health insurer, or consultant in a network management/contract management role, such as contracting, provider services, etc.
- 3+ years experience in data analysis
- 3+ years project management or project lead experience
- 3+ years presentation development and delivery experience
- Proficiency in MS Office (Excel, Access and PowerPoint)
Assets:
- Work experience demonstrating ability to develop positive working relationships with providers
- Intermediate level of proficiency with all facility/ancillary contract reimbursement methodologies
- Experience working with Long Term Care Products
- 3+ years experience with claims systems
- Strong knowledge of business processes that impact facility/ancillary contact loading and auditing
- 3+ years experience with contract submission, validation and maintenance
- 5+ years experience managing staff
- Ability to convey complex or technical information effectively
- Excellent communication skills, verbal and written and with diverse levels of leadership
- Undergraduate degree
UnitedHealthcare Community State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community State.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
