12 days old

Senior Network Program Specialist - UHC C&S - LTC - Maitland, FL - 925173

Maitland, FL 32751
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  • Job Code
    925173

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)

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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.

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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 determine how clinical providers group up by specialty and service line. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 7 leader.

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The Senior Network Program Specialist leads and supports the Network Operations team. This position will report to the Director of Network Programs, Long Term Care and will support the Manager of Network Programs as well as the Sr Provider Relations Advocate team. Responsibilities also include establishing and maintaining strong business relationships with providers in the Long Term Care and Comprehensive health plan (Medicaid dual MMA and LTC). This role will have oversight of LTC Provider Credentialing and Re-Credentialing and will present provider packets and files to the Health Plan Credentialing Committee. The Sr. Network Program Specialist will be primarily responsible for network reporting and ensuring the network composition includes an appropriate distribution of provider specialties.

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Primary Responsibilities:

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  • Applying basic knowledge of theories, practices and procedures in a function or skill
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  • Performing routine or structured work
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  • Responding to provider network inquiries
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  • Use existing procedures and facts to solve routine problems or conduct routine analysis
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  • Depend minimally on others for instruction, guidance or direction
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  • Workwell in a team environment
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  • Serve as team lead for Network Contract Associates, network operations
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  • Works closely with Provider Advocate team, supporting network needs
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  • Communicates with providers via phone/email/letters
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  • Use Microsoft Excel for data tracking, trending, and reporting
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  • Work with existing database to extract reports and manipulate data to produce required results
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  • Produce PowerPoint presentations to include graphs and charts
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  • Utilize Microsoft Word for communication tools to include mail-merge documents
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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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  • Associate Degree (or equivalent on-the-job experience) in Business or Healthcare Administration
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  • 5+ years of Provider Relations, Provider Services
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  • 5+ years of Managed Care Network and Contracting
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  • 5+ years of Network Reporting (data management, manipulation, reporting)
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  • 3+ years of contract processing, loading, fee table management
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  • 3+ years of Health Plan Medicaid claims knowledge
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  • 3+ years of Provider Credentialing
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  • 3+ years in Medicaid Long Term Care Managed Care, Network Management
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  • Experience in performing network adequacy analysis
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  • Experience with provider contracts and fee tables
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  • Experience working with provider credentialing applications
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  • Advanced Microsoft Excel
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  • Intermediate Microsoft Access, Word, and PowerPoint
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  • Proficiency in Internet searches and website utilization
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  • Strong customer service 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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  • Bachelors Degree
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  • Experience working with provider claims
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  • Spanish bilingual
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  • Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying confidential and detailed information in a manner that others can understand, as well as ability to understand and interpret detailed information from others
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  • Strong interpersonal skills, establishing rapport and work well with cross-functional teams
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  • Attentive to detail
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This position will be located in the Maitland Florida office with partial weeks working at home. The goals of our LTC (Long Term Care) network team are to manage and carry out the provider network requirements for the Health Plan according to the SMMC (State Medicaid Managed Care) contract with the state regulator AHCA (Agency for Healthcare Administration).

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Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

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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: Healthcare, Managed Care, Hospital Contracting, Physician Contracting, Ancillary Contracting, Facility Contracting, Provider Network, Network Development, Provider Services, Contract Negotiating, Network Management, Long-Term Care, Provider Relations, Provider Support, Network Support, Credentialing, Document Processing, Contract Loading, Claims, Data Reporting Skills, Excel, Access, Maitland, FL, Florida

Posted: 2021-06-04 Expires: 2021-07-04

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 - UHC C&S - LTC - Maitland, FL - 925173

UnitedHealth Group
Maitland, FL 32751

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