Provider Network Access Specialist - Remote - Remote Eligible

Caring. Connecting. Growing Together.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable.

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

Primary Responsibilities:

• Confirm contract compliance requirements to meet the needs of Turquoise Care contract network standards
• Possess knowledge of Managed Care Organization (MCO) contracting/credentialing process
• Own network adequacy reporting on behalf of health plan per state regulator requirements
• Experience working with providers/facilities in order to conduct advocacy initiatives with targeted providers to solicit participation
• Work with cross-functional teams within UnitedHealthcare to strengthen provider networks across multiple functions including but not limited to HCBS, behavioral health, physical health, dental and vision
• Work with internal groups to identify, understand, and/or improve internal tools, resources, systems, and capabilities that can maximize provider and member experience
• Analyze data to determine root cause of issue (e.g., identify trends and patterns; identify outliers and anomalies) and/or escalate problem to appropriate group for further analysis as necessary
• Act as health plan Subject Matter Expert (SME) on latest contracting status for essential providers
• Perform network analysis to identify potential strategic opportunities to increase and maintain the network
• Works with minimal guidance; seeks guidance on only the most complex tasks
• Provides explanations and information to others on difficult issues
• Acts as a resource for others with less experience
• Must be collaborative and able to work across a matrix organization
• Understands company-wide interfacing functions including Claims, UHC Operations, UHN contracting and negotiation, Service Coordination, Customer Service
• Apply knowledge of applicable health care industry practices, trends and issues to communicate about how our products/services can benefit members and providers

Included in this role is the full range of provider relations and service interactions within UHG, including working on end-to-end problem resolution, ease of use of physician portal, contract database, recruitment strategies and service negotiation parameters. Identifies network gaps and assists in the development and implementation of strategies to fill these gaps

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:

• 1+ years of working in provider network communications and provider interactions
• Working knowledge of Medicaid or MCO experience
• Experience with Network Adequacy Reporting
• Knowledge of Managed Care Organization (MCO) contracting/credentialing process
• Intermediate+ level proficiency in Excel to analyze data to determine root cause issues
• Intermediate level proficiency in MS Office (Word, SharePoint, Outlook, PowerPoint)
• Proven ability to communicate clearly and professionally with clients
• Ability to travel up to travel 10% of the time in New Mexico

Preferred Qualifications:

• 2+ years of healthcare experience
• Reside in New Mexico
• Working knowledge of SQL
• 2+ years working with health care claims

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

UnitedHealth Group 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.