Network Program Manager - Draper, UT

Company: UnitedHealth Group
Location: Draper
Posted on: June 19, 2022

Job Description:

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)The more you do, the more you learn. And as you learn you find new doors opening that challenge you to bring your best. This specialist role with UnitedHealth Group will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. We're driving ever higher levels of sophistication in how provider networks are composed and compensated. 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. -The Provider Network Program Manager with OptumCare is responsible for developing, maintaining, and servicing a high quality, marketable and satisfied provider network within an assigned geographic area. Key responsibilities include recruitment and contracting, education, and servicing of assigned providers. The Provider Network Program Manager helps assigned providers operate successfully within our healthcare delivery model by providing strategic planning and tools to meet goals. This position is expected to build and sustain strong working relationships with cross-functional departments, vendors, local sales, and assigned providers. The Provider Network Program Manager is accountable for overall performance and profitability for their assigned groups, as well as ownership and oversight to provide redirection as appropriate.Primary Responsibilities:

• Educate providers to ensure that they have the tools they need to meet quality, risk adjustment, growth (as appropriate), and total medical cost goals per business development plans facilitated through strategic meetings
• Ensure providers have in-depth understanding of OptumCare model to include, but not limited to, patient care best practices, contractual obligations and program incentives
• Conduct detailed analysis of various reports by tracking data to develop a strategic plan to ensure performance goals are achieved
• Ensure the overall strategic plan incorporates interventions with internal departments including Medical Directors, Clinical Educators/Coders, Quality/HEDIS nurses, pharmacists and others as needed
• Collaborate with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs and/or Specialists
• Conduct new provider orientations and ongoing education to providers and their staffs on OptumCare programs, processes and compensation arrangements
• Maintain open communication with providers to include issue resolution on health plan issues related to credentialing, claims, eligibility, disease management, utilization management, quality, and risk adjustment program.
• Collaborate with provider groups to develop, execute, and monitor performance and patient outcomes improvement plans
• Handle or ensure appropriate scheduling, agenda, materials, location, meals, and minutes of provider meetings as needed
• Collaborate with contracting team to ensure provider data is correct and provider directories include any needed updates
• Represent OptumCare by coordinating company sponsored provider events (summits, learning sessions)
• Regularly meet with cross-functional team to create, revise, and adjust strategy for assigned provider groups to meet overall performance goals
• Introduce and advocate company resources to facilitate practice optimizationYou'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:
  • 1+ years experience in data analytics
  • Demonstrated experience with making presentations to both small and large groups
  • Access to reliable transportation and ability to travel up to 75% within Northern Utah
  • Ability to work evenings and weekends on occasion based on business needs
  • Intermediate proficiency with MS Suite (including Word, PowerPoint, and Excel)
  • You will be asked to perform this role in an office setting or other company location
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodationPreferred Qualifications:
    • Bachelor's Degree or equivalent work experience
    • act management role, such as contracting, provider services, etc
    • 2+ years project management or project lead experience
    • 3+ years -working with a managed care organization or health insurer; or as a consultant in a network/contr
    • 2+ years of -experience working with claims systems
    • 2+ years of experience with facility/ancillary contracts
    • Expertise in physician/facility/ancillary contract reimbursement methodologies
    • Understanding of medical financial statements and delivery systems, provider contracting, reimbursement arrangements, and network management
    • Established knowledge of local provider community
    • Exceptional interpersonal skills with ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives, and other health plan staff
    • Ability to manage multiple priorities and maintain an organized approach
    • Create business strategies through excellent analytical and problem solving skills with effective follow throughTo protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employmentCareers with Optum. -Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do -your life's best work.(sm)Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. - - - - -UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. - - -

Keywords: UnitedHealth Group, Draper , Network Program Manager - Draper, UT, Executive , Draper, Utah