1+ months

Sr Director, Provider Engagement - Naviguard - 275384

Minnetonka, MN 55345
Apply Now
Apply on the Company Site
  • Job Code
    275384

Are you eager to make an impact on one of the most important and underserved issues in the US healthcare system? Naviguard, a fully owned UnitedHealth Group Ventures company, is on a mission to protect patients from surprise bills by building a revolutionary consumer protection business that stamps out unexpected and egregiously priced out-of-network usage. This new business is dedicated to helping patients understand and mitigate the unexpected financial risks they face. As an employee of this new business, you can expect to be a part of a dynamic organization that is fast-paced and driven by our vision to promote healthcare affordability and accountability nationwide.

""

As the Sr Director of Provider Engagement, you will be responsible for developing direction and strategy for reduction and/or elimination out of network utilization, identification provider themes and billing practices which may drive aberrant/unnecessary out of network utilization. This includes identifying the tools and processes required to identify opportunities for medical expense reduction. After identification, this role also ideates a process to achieve the expense reduction and works closely with the Director of Strategic Initiatives to test these processes and determine viability. This will include developing a process, testing of the process and defining the metrics of success. The VP, Provider Engagement must have savvy business acumen in healthcare delivery to understand the incentives that lead to unnecessary medical expense. This role will report to the Senior Vice President of Provider Strategy and Engagement.

""

Primary Responsibilities:

""
    ""
  • Identifies opportunities for reducing OON medical expense and provider revenue maximization schemes.
  • ""
  • Coordinate and facilitate provider of interest development meetings and sub-team meetings, working closely with UHC cross-functional and/or cross-segment teams including UHN, Legal,OPI and SIU personnel to develop strategy.
  • ""
  • Work closely with the internal product experts and operations team to ensure business objectives are met or adjusted based on the ongoing findings and trends
  • ""
  • Scopes the size of the opportunity and the ease of potential recovery and implementation
  • ""
  • Works with Director POI, to develop scope of pilot, needed resources and key deliverable dates, as well collaborate on the POI portal.
  • ""
  • Keeps up with industry and society trends which can adversely impact medical expense; develop prevention tactics
  • ""
  • Ability to devise unique and untested solutions to mitigate medical expense inflation and overutilization
  • ""
  • Develop relationship with EHCV teams to determine specific market needs/solutions
  • ""
  • Finalizes with Director POI, all reports, projects plans and performance reporting
  • ""
  • Setting opportunity and take out target and how performance compares to the target
  • ""
  • Adjust tactics and pivots as needed to meet the needs of an everchanging landscape.
  • "
""

Success Measures:

""
    ""
  • Development of relationships with internal and external business partners to identify a pipeline of POI opportunities.
  • ""
  • Development of processes to insure on-going monitoring of medical expense for relapsing issues and/or the identification of new
  • ""
  • Ability to achieve budget financial goals as well as motivated by stretch goals.
  • ""
  • Timely and accurate reporting
  • ""
  • Successful collaboration across Naviguard team, as well as Optum/UHC/UHG teams to create appropriate and pertinent processes to develop a dynamic tool to identify aberrant claims or provider behavior.
  • "
"

Minimum Qualifications:

""
    ""
  • 10+ Years of experience in working with providers and understanding the dynamics of physician billing strategies, business practices as well as mechanisms used to revenue enhancement
  • ""
  • Undergraduate degree in business or related field that develops strategic thinking
  • ""
  • Strong understanding of the healthcare delivery space
  • ""
  • Capable of effectively presenting ideas and selling concepts and tactics
  • ""
  • Proven ability to communicate effectively with executive-levels
  • ""
  • Skilled at eliciting and elaborating on business requirements
  • "
""

Preferred Qualifications:

""
    ""
  • Understanding of provider billing practices, opportunities and thinking process.
  • ""
  • Ability to eliminate noise in POI work and focus on root cause.
  • ""
  • 5+ Years of experience in identifying provider claims trends and anomalies
  • ""
  • 5+ Years of experience with health plan contract analysis or provider contract analysis
  • ""
  • 5+ Years leading a team
  • ""
  • Experience with C-Suite level reporting development
  • ""
  • Experience with CMS methodologies and benchmarking
  • ""
  • Strong verbal and written communicator
  • ""
  • Skills in Microsoft Excel and PowerPoint, advanced skill preferred
  • ""
  • Ability to quickly understand needs and act on those needs
  • ""
  • Ability to conceptualize and effectuate change management and 'out-of-the-box' thinking
  • "
Posted: 2021-03-17 Expires: 2021-05-16

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:
ADP Logo

Before you go...

Our free job seeker tools include alerts for new jobs, saving your favorites, optimized job matching, and more! Just enter your email below.

Share this job:

Sr Director, Provider Engagement - Naviguard - 275384

UnitedHealth Group
Minnetonka, MN 55345

Join us to start saving your Favorite Jobs!

Sign In Create Account
Powered ByCareerCast