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 Regulatory Program Consultant is responsible for the successful program design, compliance with network requirements, network assessment and selection, and program/product implementation. Network Regulatory 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. Primary Responsibilities:Anticipate customer needs and proactively develop solutions to meet themServe as a key resource on complex and / or critical issuesSolve complex problems and develop innovative solutionsPerform complex conceptual analysesReview work performed by others and provide recommendations for improvementForecast and plan resource requirementsAuthorize deviations from standardsMay lead functional or segment teams or projectsProvide explanations and information to others on the most complex issuesMotivate and inspire other team membersThis role will be working closely with our West Region Network Adequacy team, our Legal and Regulatory Department and the local CA market team to support demonstrating network adequacy in the CA market. In addition this role will support product expansion and annual network adequacy reviews to our regulators.
Required Qualifications: Undergraduate degree or equivalent work experience1+ years of claims knowledge 2+ years of provider data maintenance, contracting, or contract loadingIntermediate level of proficiency and understanding of contract reimbursement methodologiesExcellent communication skills required including ability to communicate effectively with various levels of leadershipProficiency in MS Office (Excel, PowerPoint, and Outlook).Preferred Qualifications:Project Management experience Previous experience with AccessUnderstanding of capitated, delegated provider business modelFamiliarity with regulatory as it relates to provider networksUnderstanding of Commercial, Medicare, and Medi-calCareers 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.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.Job Keywords: Compliance, Network Compliance, Regulatory, Network Regulations, Network Programs, Cypress, CA, Long Beach, CA, Santa Ana, CA, Irvine, CA, Huntington Beach, CA, California
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.