1+ months

Senior Network Program Specialist - Las Vegas, NV - 900774

Las Vegas, NV 89101
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  • Job Code
    900774

You know it. We know it. Change is sweeping through health care in ways that go beyond the basics covered in the news. People like you and organizations like UnitedHealth Group are driving ever higher levels of sophistication in how provider networks are composed and compensated. Everything is open to new ideas and innovation. And a lot of the good stuff starts in roles like this. Your expertise in provider networks can help us build in the next phase of evolution. In this role, you'll use your knowledge and analytical skills to help analyze, validate and ensure the utmost accuracy of our provider network. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 7 leader.

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""Primary Responsibilities:

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  • Manages projects related to contracting initiatives and network changes.
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  • Implement and oversee any delegated functions (i.e. credentialing)
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  • Manage projects related to network affordability initiatives
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  • Main contact for issues needing resolution on UHC platforms.
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  • Maintain Provider Summary Guide
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  • Oversee system controls within department database
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  • Sends out all provider communication approved by management
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  • Coordinate with Provider Relations on Secret Shop activities and reporting
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  • Provider Directory audit oversight and compliance
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  • Maintain referral expectation sheets for Online Provider Center
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  • Auditing of provider tools on Health Plan websites
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  • Identify potential process improvement needs
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  • Communicate with applicable stakeholders to provide performance updates regarding program/contract implementation (e.g. goals, timelines, schedules, issues, performance standards)
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  • Collaborate with relevant internal and/or external stakeholders to resolve issues and obstacles with network/program/contract performance.
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This is a unique opportunity that comes with great challenge. You'll be focused on ensuring our provider network is adequate and provides accessibility to our Nations Hero's. This position will be focused on analysis, running reports, validity of data, research and problem solving.

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Positions in this function are responsible for the successful program implementation and on-going compliance with network requirements and network assessment. May perform network analysis and strategy development and implementation. Obtains data, verifies validity of data, and analyzes data as required. Analyzes network availability and access and reports non-compliance in adequacy requirements. May make recommendations regarding use and expansion based on that analysis and research for gap-fill providers.May research contract loading errors, search for root cause and develop next steps for resolution.


You'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.

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Required Qualifications:

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  • Bachelors Degree or High School Diploma / GED with 4 years of relevant work experience
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  • 3+ years of experience with network data management in a managed care environment
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  • 3+ years of experience in provider data analysis
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  • 3+ claims resolution
  • You will be asked to perform this role in an office setting or other company location.
  • Employees are required to screen for symptoms using theProtectWellmobileapp, Interactive Voice Response (i.e., entering your symptoms via phonesystem)or a similar UnitedHealth Group-approved symptom screener prior toentering the work site each day, in order to keep our work sites safe.Employees must comply with any state and local masking orders.In addition, when in a UnitedHealth Group building, employees are expectedto wear a mask in areas where physical distancing cannot be attained.
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Preferred Qualifications:

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  • 3+ years of experience with claims processing systems and provider data bases as well as claims system testing
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  • 3+ years of experience with claims processing or resolution and medical coding
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  • 2+ years of experience working with reporting tools and generating effective reports
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  • Ability to convey complex information to others and make it more easily understood
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  • 3+ years of experience with NDB
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  • 3+ years of experience with PIMS
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  • Project management experience
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UnitedHealth Group is an essential business.The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.

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Some of the steps we've taken to ensure employee well-being include:

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  • Launched our ProtectWell app and UnitedCARES program to help ease the burden and stress for our UnitedHealth Group team members and their immediate family affected by COVID-19
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  • Daily updates from our CEO Dave Wichmann to support and inspire team members during this challenging time
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  • Onsite social distancing and increased sanitization measures for employees who have been welcomed back to our offices
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  • Fully cover the COVID-19 healthcare costs for our employees
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  • Employees who self-identify as high risk or who live with someone who is high risk have been asked to remain working from home
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You can learn more about all we are doing to fight COVID-19 and support impacted communities:click here.

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What we do defines who we are. Take a deeper look at how we're providing support during this global health crisis and search for a way you can get involved. View our COVID-19 Resources Page:click here.

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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 Groupis a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords: network, compliance, assessment, provider, data, claims, reporting, Las Vegas, NDB, PIMS, hiring immediately

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Posted: 2020-11-25 Expires: 2021-01-24

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.

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Senior Network Program Specialist - Las Vegas, NV - 900774

UnitedHealth Group
Las Vegas, NV 89101

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