Network Program Manager (Remote in northern AZ)

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. 

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
• Intermediate proficiency in MS Office (Excel, Access and PowerPoint)
• Expertise in physician/facility/ancillary contract reimbursement methodologies
• 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 northern Arizona 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

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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.