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. Primary Responsibilities:
- Set team direction, resolve problems, and provide guidance to members of own team
- Adapt departmental plans and priorities to address business and operational challenges
- Direct cross-functional and/or cross-segment teams to develop enterprise-wide Clinically Integrated Networks focused on specific clinical areas/service lines, such as oncology or cardiology
- Oversee network analysis and strategy development and implementation
- Drive program design and implementation to improve quality and affordability through improvements in appropriateness and effectiveness
- Ensure teams are obtaining, validating, and analyzing data impacting network availability and access
- Undergraduate degree or equivalent work experience
- 5+ years of experience working with a managed care organization or health insurer, or as a consultant in a network/contract management role, such as contracting, provider services, etc.
- 5+ years of experience managing staff
- Proficiency with all physician/facility/ancillary contract reimbursement methodologies
- Strong knowledge of business processes that impact network contact loading and auditing
- Proficiency with MS Office Suite, including Excel
- Ability to travel nationally approximately 75%
- Project management or project lead experience
- Experience with claims systems
Building diverse, high quality provider networks is creating greater access to health care and improving the lives of millions. Join us. Learn more about how you can start doing your life's best work.(sm)
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team 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.
Job keywords: managed care, health care, network program specialist, network requirements, network assessment, network selection, network data management, provider data analysis, medical claims, recovery resolution, medical coding, project manager, supervisor, manager, San Antonio, TX, Texas