Associate Director, Health Plan Provider Operations - Telecommute in Massachusetts

Company: UnitedHealth Group
Location: Salem
Posted on: May 14, 2022

Job Description:

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) In this role, you will be responsible for managing the facilitation and implementation of each provider contract through various functional teams across a highly matrixed organization. Join us! - There's never been a better time to do your life's best work.(sm) -The person in this role may be a full-time telecommuter but must reside in the state of Massachusetts, be ability to travel to the Waltham office regularly, and be willing and able to travel to provider site visits throughout the state of Massachusetts as needed.Primary Responsibilities:

• Negotiate successful contracts with Home and Community Base Services (HCBS) providers, Aging Services Access Points (ASAPs) and atypical vendors
• Coordinate internal resources and to support third party vendors in meeting our business goals
• Work with leaders on negotiating Value Base contracting and developing a work plan to prepare providers for VBP contracting with Risk-sharing, if appropriate
• Work collaboratively with legal across the enterprise to create network participation contracts, payment appendixes and amendments to base contract templates with the necessary customizations to produce final documents for signature
• Partner with cross functional teams around claims system configuration for contracted providers to ensure services rendered are appropriately reimbursed
• Manage regulatory requirements from State regulator to support implementation of new services, rate changes and various reports
• Manage all aspects of provider servicing including managing a team that is responsible for a portfolio of provider accounts
• This includes building trusting relationships to remediate issues related to claims, prior authorization, member enrollment
• Develop detailed project plans and track progress of new products, services and address potential issues
• Schedule and facilitate meetings in-person with providers monthly as well as leading townhalls meetings to support provider education
• Report and escalate high priority issues to senior managementYou'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:
  • Undergraduate degree in Healthcare, Business Administration, Public Health Policy or related field
  • 3+ years of experience managing healthcare provider and/or vendor relationships
  • 3+ years of experience in Managed Care contract negotiations and provider relations
  • 3+ years of experience in Health Insurance Claims, including knowledge of CPT and ICD-10 coding -
  • Experience with implementing new programs and initiatives in a large matrixed organization with multiple governance structures
  • Intermediate or higher proficiency in Excel, Word, and PowerPoint
  • Full COVID-19 vaccination is an essential requirement 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 compliancePreferred Qualifications:
    • Knowledge of provider network and provider services
    • Experience leading teams
    • Great organization and time-management skills and the ability to manage multiple projects simultaneously
    • Ability to build relationships with external providers, agencies, and vendorsTo 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 employment.Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 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)*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. 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.

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