Network Adequacy Specialist – National Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities: 

• Triage orders incoming to provider network to identify network options available to provide service
• Manually assign qualified providers to orders within the contractually allowed mileage radius of the patient’s home zip code. Identify reasons for manual assignment, initiate corrective action for improvements and efficiencies as required
• Assign work to other areas of Provider Network as applicable to meet needs of the order/customer
• Provide explanations and information to others on topics within area of expertise
• Track and report contracting efforts to successfully monitor pending orders in assigned territories for quick order assignment and scheduling
• Attend POD discussions to speak to held orders that are a work in progress to provide updates to internal and external customers
• Work orders through the Vendor Order Fulfillment process by locating a provider that can perform needed services

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:

• High School Diploma / GED (or higher)
• 1+ year of related experience with network management, coverage analytics, data management, and/or customer service
• 1+ year of experience with Database experience (i.e. Med Net)
• 1+ year of experience with demonstrating the ability to analyze, interpret and translate workflow and provider network data
• Intermediate level of proficiency with Microsoft Office programs

Preferred Qualifications:

• 2+ years of related experience (network management, coverage analytics, data management and/or customer service)
• Medical, dental or healthcare insurance experience
• Experience with auditing and analyzing healthcare providers

Soft Skills:

• Strong analytical and problem solving skills with ability work independently
• Strong written and verbal communication skills

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Maryland, Washington, or Washington D.C Residents Only: The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Maryland, Washington, or Washington D.C residents is $23.22 to $45.43 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all 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. 

 

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

 

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

 

  

 

 #RPO #GREEN