7 days old

Health Plan Business Process Manager - Telecommute - 938494

Minneapolis, MN 55415 Work Remotely
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  • Job Code
    938494

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

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In this role, you will be responsible for specific services, functions, and solutions available internally or as a supporting element of a product, typically not sold stand-alone externally. You will play a critical role in the ability to deliver products to market and/or manage internal business functions. Your role requires alignment to business and/or product strategy, effective design and development, and ongoing management of capability portfolio across the full lifecycle to ensure business-specific or cross-enterprise impact. You will leverage market insights to monitor trends and external landscape, and to inform capability strategies and customer use case scenarios. You will be accountable for delivering sustainable, financially sound solutions that solve a specific problem and enable successful external product delivery and/or internal business function performance, while driving adoption with internal business clients and define future capability direction that supports business strategy and new opportunities.

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Youll enjoy the flexibility to telecommute* from anywhere within United States as you take on some tough challenges.

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Components of the Cross-Enterprise business areas and functions

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  • Optum Care Delivery Operations:"""
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    • Configuration (Plan, Benefit, Pricing / Fee Schedule)
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    • Eligibility (Member; load, maintain, reconcile)
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    • Provider Data (load, maintain, reconcile)
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    • Prior Authorization (intake and processing)
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    • Utilization Management
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    • Provider Service Center
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    • Claims Operations (intake, adjudication, research and adjustments, quality assurance / audits, encounter data reconciliation, claims automation)
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    • Operations Support Services (Training, Documentation, Testing)
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    • Project Management (PM, BA, Reporting)
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    • Market Operations (Service Account Management)
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  • Upstream and downstream Operational dependencies (Optum or Market operations)""
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    • Network Strategy, Development and Management
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    • Provider Contracting
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    • Provider Credentialing
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    • Network / Provider Relations
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    • Patient Acquisition and Retention
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    • Medical Management (CM, DM, CCM)
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    • Print and Mail Room Operations
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    • Payment Integrity and Claims Editing
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    • Finance (Cap reconciliation, provider payment, EFT / ERA)
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    • Risk and Quality
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    • Regulatory
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    • Compliance
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    • Reporting
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Core Activities:

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  • Develop, own and maintain the Optum Care Delivery Operations Health Plan Product Playbooks which details the Operational implementation and maintenance requirements, impacts and processes for unique health plan products. This Playbook is an internal document that at minimum should contain:"""
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    • Analysis of the Health Plan Product""""
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      • Product overview: unique design elements, regulatory and compliance considerations, member and provider requirements, Operational functions impacts
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      • Requirements analysis and documentation (people, process and technology)
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    • Optum Care Delivery Operations core functions impacts for both implementation and maintenance:"""
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      • Impact analysis by function
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      • Staffing overview / FTE requirements
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      • Process Flows
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      • Implementation Analysis:""""
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        • Gaps, solutions, workplan, timelines
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        • Budget considerations; capital, technology, other
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        • Partner with Financial Analysts to determine implementation and maintenance costs PMPM
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    • Executive and leadership slideware
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  • Coordinate with Optum Care Operations Delivery leaders review the Health Plan Product requirements and to determine impacts. Align with Optum Implementation Resources (Project Managers / Business Analysts) to analyze operational requirements, identify gaps and draft solutions. Facilitate work-sessions with other Optum resources (Technology, Finance, others) to discuss requirements, dependencies and solutioning. Facilitate activities to identify gaps, deliverables, timelines and required actions and owners
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  • Develop supportive documentation: Business Requirements Documentation and Traceability artifacts, Process flows, Solution Descriptions, Timelines, Implementation Gantt charts, Budget overviews, etc. Use this material to create a Playbook document that gives a detailed overview of the Health Plan Product and Operational approach for implementation and maintenance as outlined above
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  • Arrange / coordinate and conduct an Executive and Operational Leaders Read-out Session and deliver an overview of the product and proposal. Update / finalize plans as needed
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  • Work with Optum Care Operations Delivery resources to handoff the Playbook for operationalization. Support implementation as needed, acting as the Product SME
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  • Update and maintain all materials in appropriate locations
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  • Utilize Best Practices and Lessons Learned to update / modify the Playbook for use in future implementations. Partner with others to identify optimization for both implementation and maintenance with a goal of reducing the Optum Care Operations Delivery PMPM costs
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Key Competencies:

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  • Business, Market, Client and Customer focus"""
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    • Ability to explain value of capability
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    • Partners with SMEs
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    • Ability to learn operational business
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  • Financial Acumen""
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    • Compiles analysis to support capital requests
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    • Understands the technologies used to deliver cross-business solutions to effectively inform direction and scope of opportunity across business
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  • Relationship Management""
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    • Build a network of leaders inside and outside of organization; deepens relationships with key stakeholders
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    • Demonstrates understanding of formal and informal work roles, team goals, interests and relationships that make up the cross-group capability working team; Facilitates communication, considers multiple perspectives, and informs decisions necessary to implement initiatives; Plans, coordinates and manages internal resources to accomplish assignments within the given deadlines
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  • Leadership""
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    • Influences both directly and indirectly
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    • Takes accountability
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    • Considers long-range objectives
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  • Critical Thinking""
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    • Identify and gather relevant data; utilize data to evaluate solutions and challenges
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    • Applies operational rigor
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  • Adaptable""
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    • Operated effectively with ambiguity; leverage internal network
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Youll 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.

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Required Qualifications:

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  • 5+ years of experience in health plan operations such as claims operations, health plan configuration, utilization management, provider service center or similar operations
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  • 3+ years supporting projects as a Business Analyst, Project Manager, or other project leader capacity with health insurance lines of business such as Medicare Advantage, Medicaid, Commercial, Dual eligible plans
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  • Demonstrated understanding of the membership types, plan requirements and impacts on operations
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  • Advanced user of Visio and PowerPoint
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  • Intermediate user of Microsoft Office Suite to include Excel and Word
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  • Demonstrated understanding of health plan operations lifecycle
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
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Preferred Qualifications:

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  • Understands and articulates how capability aligns to business strategy and future roadmap; considers industry trends, target markets, lines of business
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  • Data and business process analysis and visualization
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  • Decision-making utilizing facts and criteria
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  • Document, iterate and manages artifacts across the full lifecycle
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Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

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Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

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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.

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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords: Health Plan Products Operations Manager, Operations, Prior Authorization, Provider Data, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH

Posted: 2021-06-11 Expires: 2021-07-11

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

Sponsored by:
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Health Plan Business Process Manager - Telecommute - 938494

UnitedHealth Group
Minneapolis, MN 55415

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