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.
Keywords: UnitedHealth Group, Salem , Associate Director, Health Plan Provider Operations - Telecommute in Massachusetts, Executive , Salem, Massachusetts
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