Provider Network Access Specialist

2 weeks ago

Albuquerque, New Mexico, United States UnitedHealth Group Full time
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:


Confirm contract compliance requirements to meet the needs of Turquoise Care contract network standardsPossess knowledge of Managed Care Organization (MCO) contracting/credentialing processExperience working with providers/facilities in order to conduct advocacy initiatives with targeted providers to solicit participationWork with cross-functional teams within UnitedHealthcare to strengthen provider networks across multiple functions including but not limited to HCBS, behavioral health, physical health, dental and visionWork with internal groups to identify, understand, and / or improve internal tools, resources, systems, and capabilities that can maximize provider and member experienceAnalyze data to determine root cause of issue (e.g., identify trends and patterns; identify outliers and anomalies) and / or escalate problem to appropriate group for further analysis as necessaryOwn network adequacy reporting on behalf of health plan per state regulator requirementsAct as health plan Subject Matter Expert (SME) on latest contracting status for essential providersPerform network analysis to identify potential strategic opportunities to increase and maintain the networkWorks with minimal guidance; seeks guidance on only the most complex tasksProvides explanations and information to others on difficult issuesActs as a resource for others with less experienceMust be collaborative and able to work across a matrix organizationUnderstands company-wide interfacing functions including Claims, UHC Operations, UHN contracting and negotiation, Service Coordination, Customer ServiceApply knowledge of applicable health care industry practices, trends and issues to communicate about how our products / services can benefit members and providersIncluded in this role is the full range of provider relations and service interactions within UHG, including working on end-to-end problem resolution, ease of use of physician portal, contract database, recruitment strategies and service negotiation parameters.

Identifies network gaps and assists in the development and implementation of strategies to fill these gapsYou'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.


Required Qualifications:
2+ years of healthcare experience2+ years in managing or working with health care claims1+ years of working in provider network communications and provider interactionsPossess knowledge of Managed Care Organization (MCO) contracting/credentialing processIntermediate+ level proficiency in ExcelIntermediate level proficiency in MS Office (Word, SharePoint, Outlook, PowerPoint)

Proven ability to communicate clearly and professionally with clientsPreferred Qualifications:
Experience with Network Adequacy ReportingWorking knowledge of Medicaid or previous MCO experienceLive in New Mexico and be able to travel 10% of the time*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter PolicyCalifornia, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or

Washington Residents Only:
The salary range for this role is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with al minimum wage laws as applicable.

In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.


Application Deadline:

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected.

Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.

We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life.

Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes.

We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.


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.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.#J-18808-Ljbffr

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