Director Provider Network – Remote

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 Provider Network Director will oversee the development, maintenance, and optimization of the provider network, with a solid emphasis on understanding and resolving claims issues. This role requires a strategic mindset, critical thinking, and a deep understanding of the VA System, claims adjudication logic, and claims systems.

 

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

 

Primary Responsibilities:

Provider Network Claims Management and Issue Resolution:

• Analyze and understand the impact of claim issues on the provider network
• Develop and implement strategic steps to resolve claim issues promptly
• Collaborate with claims adjudication teams to ensure accurate and timely processing
• Monitor claims systems for potential issues and initiate corrective actions
• Collaborate with Provider Education to develop education strategies on best billing practices

Provider Network Development:

• Establish and maintain relationships with healthcare providers and systems
• Negotiate contracts and agreements with providers to ensure comprehensive coverage
• Identify gaps in the network and strategize expansion efforts
• Ensure compliance with industry standards and regulations

Strategic Planning and Critical Thinking:

• Develop long-term strategies for network growth and improvement
• Utilize critical thinking to solve complex problems and make informed decisions
• Analyze data to identify trends and opportunities for network enhancement

Provider Network QA and Performance Monitoring:

• Develop and implement quality assurance protocols as it relates to Provider Network
• Conduct regular audits and assessments of provider performance
• Identify areas for improvement and implement corrective actions
• Report on quality metrics and outcomes to senior management

Leadership and Collaboration:

• Foster a collaborative environment to achieve network goals
• Communicate effectively with internal and external stakeholders

 

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:

• 10+ years of experience in the health care industry
• 8+ years of experience in a network management-related role handling complex network providers with accountability for business results
• 5+ years of experience with provider contracting including development of product pricing and utilizing financial modeling in making rate decisions
• Proven in-depth knowledge of Medicare Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.

 

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

 

The salary range for this role is $124,500 to $239,400 annually based on full-time employment. 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. 

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.  

 

 

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

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