Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)The Network Program Consultant is responsible for the successful program design, compliance with network requirements, network assessment and selection, and program/product implementation. This includes enterprise-wide Clinically Integrated Network teams that focus on specific clinical area Lines of Service to improve quality and affordability through improvements in appropriateness and effectiveness. Network Program Consultants may perform network analysis and strategy development and implementation; obtain data, verify validity of data, and analyze data as required, and analyze network availability and access. Other responsibilities may also include making recommendations regarding use, expansion, selection of networks for various products based on that analysis. This role is part of the "PBR" team. PBR is the Provider Risk Based Contracting and Delegated Review Process. The ideal location for this role is Cypress, CA. However other locations and telecommute are options if needed.Primary Responsibilities:Manage a workload of multiple PBR "projects" with up to ten functional owners. Projects include driving the review of potential and current delegated networks entitiesOwner of the areas SharePoint siteWork to automate department reports. Example would include determining if data from multiple dashboards can be auto populated into the DOC / DOGC dashboardSupport on going needs associated with getting UHN and market trained on the required process of the "ROTR" (Rules of the Road) and PBR submissionManage process of updating policies and proceduresAnticipate customer needs and proactively develop solutions to meet themServe as a key resource on complex and / or critical issuesMay lead functional or segment teams or projectsProvide explanations and information to others on the most complex issues
Required Qualifications: 4+ years of experience in contracting, claims processing, provider data maintenance, or contract loading4+ years of experience with all facility / ancillary contract reimbursement methodologies2+ years project management experience3+ years of experience with contract submission, validation and maintenance2+ years of experience working with leadership at higher levels Advanced proficiency in MS Office Excel, Access and PowerPointPreferred Qualifications:In depth knowledge in at least one of three core knowledge areas: Claim, Clinical or CredentialingStrong knowledge of business processes that impact facility/ancillary contract loading and auditingExcellent communication skills; including the ability to influence decisions with data4+ years of experience working with Claim systems2+ years of experience managing a SharePoint site Proven ability to work in a fast paced environment with minimal supervision while still meeting deadlines with project assignmentsUndergraduate or higher level degreeCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SMDiversity 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. Job Keywords: contracting, claims processing, provider data maintenance, contract loading, facility / ancillary contract reimbursement methodologies, project management, remote, telecommute, telecommuter, telecommuting, Cypress, CA, California, Arizona, Colorado, Florida, Texas
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.