11 days old

Senior Network Program Specialist - Telework (Must be in CT) - 935061

Farmington, CT 06032 Work Remotely
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  • Job Code
    935061

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your lifes best work.(sm)

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As part of the OptumCare Network of CT, the Senior Network Program Specialist will be responsible for the successful program design, compliance with network requirements, network assessment and selection, and program/product implementation. This includes enterprise wide Clinically Integrated Network teams that focus on specific clinical area Lines of Service (e.g., Cardiology, Women's Health, Oncology, etc.) to improve the quality and affordability through improvements in appropriateness and effectiveness. 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. May make recommendations regarding use, expansion, selection of networks for various products based on that analysis. This is primarily a remote position with 1 day a week in our Farmington office.

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If you are located in the state of CT, you will have the flexibility to telecommute* as you take on some tough challenges.

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Primary Responsibilities:

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  • Gather data from relevant sources in order to respond to stakeholders' requests (e.g., employer groups; internal teams) Communicate effectively and directly with internal and external customers at all levels within the organization
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  • Ensure relevant contract and demographic information is loaded into the applicable platform in order to support analysis and review
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  • Review and/or analyze member / provider population information (e.g., cultural information; demographics; geographic coverage) in order to determine potential network gaps in care and risk adjustment indicator opportunities
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  • Implement new rates with contracted providers based on provider performance -Validate network data for programs (e.g., transparency program)
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  • Develop metrics and create performance reports for pay-for-performance programs (e.g., PBC; PCPI)
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  • Provide guidance to internal stakeholders regarding administration of contracts (e.g., contract language, coding)
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  • Create and/or implement communication / training materials (e.g., talking points; FAQs; step action chart; metric evaluation tools) in order to educate affected stakeholders on new programs and/or processes
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  • Conduct visits with external health care providers to promote risk adjustment score accuracy (e.g., early detection; accurate documentation and coding) and compliance with applicable regulatory guidelines (e.g., CMS; HEDIS / STARS Quality Measures)
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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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  • Follow-up with stakeholders to ensure issues have been resolved and addressed effectively and timely -Manage external relationships with third-party vendors to ensure program SLAs are met
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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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  • Bachelors Degree or equivalent experience
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  • Advanced Excel - strong Data Analytics skills
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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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  • Strong knowledge of the Payer Relations, Network programs and Provider Rosters
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  • Provider credentialing
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  • Understanding of claims platforms
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  • Understanding of contracting strategies (e.g., facility; ancillary; physician) in order to support field objectives / MBOs
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  • Understanding of key provider / contract / network performance and/or risk adjustment indicators (e.g., prevalence rate; recapture rates; MWOV; RAF scores)
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Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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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*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: Senior Network Program Specialist, Network Program Specialist, Network Provider, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH, Farmington, CT, Connecticut

Posted: 2021-06-10 Expires: 2021-07-17

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 - Telework (Must be in CT) - 935061

UnitedHealth Group
Farmington, CT 06032

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