Senior Provider Engagement Representative – Remote in Indiana

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 Senior Provider Engagement Representative is accountable for the full range of provider relations and service interactions within UHG, 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.

 

Designs and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and business office managers. Directs and implements strategies relating to the development and management of a provider network.

 

Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs. May also be involved in identifying and remediating operational short-falls and researching and remediating claims.

 

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

 

Primary Responsibilities:

• Ability to travel throughout the Market to provide service and expand relationships with skilled nursing facilities and/or assisted living communities
  
• Capable of managing a variety of complex issues while driving key projects
  
• Develop and maintain professional working relationships with skilled nursing home/assisted living providers in a region
  
• Work collaboratively with colleagues and staff to create a results-driven, team-oriented environment, strong relationship development and other interpersonal skills
  
• Intermediate level of proficiency in claims processing and issue resolution
  
• Knowledge of Medicare and/or Medicaid regulations and requirements including payment guidelines and various reimbursement methodologies
  
• Familiarity with local and national market trends in skilled nursing community and in managed care industry
  
• Strong customer service skills, and ability to manage multiple priorities and rapid change
• Able to easily adapt, thrive and commit to an evolving environment
  
• Good organization and planning skills
  
• Ability to prioritize and meet deadlines from multi-staff members within the department
  
• Ad Hoc projects as needed
  
• Solves moderately complex problems and/or conducts moderately complex analyses
  
• Provides explanations and information to others on difficult issues
  
• Coaches, provides feedback, and guides others
  
• Acts as a resource for others with less experience
  
• External Facing: Virtual visits and on-site meetings with skilled nursing and/or assisted living facility staff as needed
  
• Review SNF claim reports and provide education based on root cause analysis and outcome
  
• Outreaches providing proactive education to partnered SNFs based on claim issue trends, UHC policy, and procedures, best practice and network initiatives (i.e. BRM, JOC, prior authorization, catalog benefit) 
  
• Collaborate with naviHealth and SNF providers to ensure quality of care
  
• Research escalated issues and communicate outcomes
  
• Maintain SNF contacts, meeting tracking, and outreach education documentation in Compass
  
• Review and communicate incentive plan outcomes and payment structure to facility
  
• For ISNP provide training and education on accessing network of providers through benefit orientations
  
• For ISNP review and analyze medication adherence data by creating monthly reports for skilled nursing and clinical team to review
  
• Collaborate with provider associations, advisory boards, and provider conferences as needed
  
• Mentoring others inside and outside of the Market.
• Special Projects as assigned by Supervisor or Market leaders.

 

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 provider relations or provider network management experience
  
• Experience with Medicare/Medicaid regulations
  
• Intermediate level of proficiency with MS Word, Excel, PowerPoint and, Outlook
  
• Excellent presentation skills with the ability to present in a group setting, both virtually and in person
  
• Ability to travel within the Indiana area
  

 

Preferred Qualifications:

• Provider contracting, provider relations and/or provider network experience with a background in skilled nursing and/or assisted living industry preferred
  
• Ability to prioritize and meet deadlines
  
• Familiarity with claims processing and issue resolution

 

*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.