Network Program Manager- Phoenix AZ – Hybrid/Field Role

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. 

The Network Program Manager is 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 programs or initiatives, to improve the quality and affordability through improvements in appropriateness and effectiveness. Network Program Manager may perform network analysis and strategy development and implementation; obtain data, verify validity of data, and analyze data as required, and analyze network availability and access. Other responsibilities may also include making recommendations regarding use, expansion, selection of networks for various products based on that analysis.

This is a Field based role in Phoenix, AZ (Northwest Valley/West Side) with 2 days in the office (Monday and Friday).

Primary Responsibilities:

• Wide range of activities pertaining to strategic planning and analysis, medical data analysis (RAF), disease management, chronic care models, and STARs/HEDIS quality interactions
• Educates PCPs and their staff members on health plan products and processes, develops project plans which identify key issues, problems, approaches, performance metrics and resources required and provides staff leadership to multi-disciplinary teams. Serves as a liaison between provider and OptumCare 
• Maintain and obtain contracts within assigned territory
• Assess and interpret customer needs and requirements 
• Identify solutions to non-standard requests and problems 
• Solve moderately complex problems and/or conduct moderately complex analyses 
• Work with minimal guidance; seek guidance on only the most complex tasks 
• Translate concepts into practice 
• Provide explanations and information to others on difficult issues 
• Coach and provide feedback to assigned PCP practices on OptumCare processes
• Act as a resource for others with new staff or others with less experience

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.

Required Qualifications:

• 5+ years of experience with network data management in a managed care environment 
• 2+ years of experience working with claims systems
• Expertise in physician/facility/ancillary contract reimbursement methodologies
• Intermediate proficiency in MS Office (Excel, Access and PowerPoint)
• Proven ability to work closely with providers to meet OptumCare policies and procedures
• Proven ability to convey complex information to others and make it more easily understood 
• Proven ability to prioritize multiple tasks in an environment of rapid change 
• Live within the greater Phoenix area

Preferred Qualifications:

• 3+ years of experience with claims processing systems and provider databases
• 3+ years of experience in provider data analysis and communicating metrics
• 3+ years of Medicare Advantage experience, risk adjustment, HEDIS, and working closely with providers in these areas
• Proven excellent communication skills, including ability to communicate effectively with various levels of leadership