Provider Relations Manager – Remote in SC, VA, NC

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As the Provider Relations Engagement Manager, you will be responsible for the full range of provider relations and service interactions for Optum’s multi-payer delegated membership, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training & development of external provider education programs. As the Provider Relations Manager, you will design and implement programs to build and nurture positive relationships between Optum Health Networks and its external partners, including but not limited to health plan(s), providers (physician, hospital, ancillary, etc.), and practice managers. Your responsibilities will also include directing and implementing strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development of staff in prioritizing contracting needs, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims. In this role you will serve as the primary contact point and face of Optum within the Mid-Atlantic to the provider and play a significant role in creating and maintaining trusting and sustainable relationships with our providers to better serve the health needs of our members and their patients.

If you are located in Mid Atlantic, you will have the flexibility to work remotely* as you take on some tough challenges. 

Primary Responsibilities:

• Assess and interpret OHN partner needs and requirements
• Identify solutions to non-standard requests and problems
• Solving moderately complex OHN partner problems (claims, portal, provider data etc.) while working under minimal guidance; seeking guidance on only the most complex tasks
• Provide explanation and information on difficult issues 
• Identify, organize, track and deliver on identified solutions
• Support initiatives to achieve measurable partner service experience improvements in the region
• Present regional and market level performance reports to management on project updates, project cycle, and expected results
• Support the education of OHN across all regional partner types
• Monitor industry trends and resources and defines opportunities to enhance provider service offerings
• Coordinate extensively with cross functional internal teams to provide and gain a full understanding of provider group challenges
• Demonstrate an expert understanding of claims processes and can work through problems to find a solution
• Develop an intimate knowledge of the providers’ practice
• Bring the “voice of the provider” to help shape Optum initiatives and nurture relationships with providers and internal contacts

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:

• 3+ years of fee-for-service/ACO/value-based care contracting or managed care experience at an integrated delivery system, population health services company or health insurance plan
• Experience working with provider data and contract configuration systems
• Working experience in medical group, claims, or credentialing department
• Advanced knowledge of Microsoft PowerPoint; proficiency in Microsoft Excel and Word
• Proficiency in Microsoft Excel 
• Solid understanding of Medicare Advantage, value-based and fee-for-service concepts including Medicare payment methodology, rates, and fee for service reimbursement methodologies 
• Proven exceptional written and oral presentation skills with the ability to engage external audiences and build credibility and trust
• Proven solid ability to nurture and maintain relationships
• Proven self-starter with solid analytical, critical thinking and problem-solving skills, able to work with minimal supervision
• Proven solid analytical and problem-solving skills
• Proven solid communication skills, including an ability to communicate with staff at various levels, including both front line staff and senior management both internally and externally

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 

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.