Provider Network Program Manager - Telecommuter residing in Coeur d'Alene, ID

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Optum is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry.

The Provider Network Program Manager with OptumCare is responsible for developing, maintaining, and servicing a high quality, marketable and satisfied provider network within an assigned geographic area. Key responsibilities include recruitment and contracting, education, and servicing of assigned providers. The Provider Network Program Manager helps assigned providers operate successfully within our healthcare delivery model by providing strategic planning and tools to meet goals. This position is expected to build and sustain strong working relationships with cross-functional departments, vendors, local sales, and assigned providers. The Provider Network Program Manager is accountable for overall performance and profitability for their assigned groups, as well as ownership and oversight to provide redirection as appropriate.

If you live in Pocatello, Boise or Twin Falls, Idaho, you will have the flexibility to telecommute as you take on some tough challenges.

This position will require travel within Southern Idaho.

Primary Responsibilities:

• Educate providers to ensure that they have the tools they need to meet quality, risk adjustment, growth (as appropriate), and total medical cost goals per business development plans facilitated through strategic meetings
• Ensure providers have in-depth understanding of OptumCare model to include, but not limited to, patient care best practices, contractual obligations and program incentives
• Conduct detailed analysis of various reports by tracking data to develop a strategic plan to ensure performance goals are achieved
• Ensure the overall strategic plan incorporates interventions with internal departments including Medical Directors, Clinical Educators/Coders, Quality/HEDIS nurses, pharmacists and others as needed
• Collaborate with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs and/or Specialists
• Conduct new provider orientations and ongoing education to providers and their staffs on OptumCare programs, processes and compensation arrangements
• Maintain open communication with providers to include issue resolution on health plan issues related to credentialing, claims, eligibility, disease management, utilization management, quality, and risk adjustment programs
• Collaborate with provider groups to develop, execute, and monitor performance and patient outcomes improvement plans
• Handle or ensure appropriate scheduling, agenda, materials, location, meals, and minutes of provider meetings as needed
• Collaborate with contracting team to ensure provider data is correct and provider directories include any needed updates
• Represent OptumCare by coordinating company sponsored provider events (summits, learning sessions)
• Regularly meet with cross-functional team to create, revise, and adjust strategy for assigned provider groups to meet overall performance goals
• Introduce and advocate company resources to facilitate practice optimization

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:

• Bachelors Degree or equivalent work experience
• 3+ years of experience working with a managed care organization or health insurer OR IN A PRIMARY CARE SETTING; or as a consultant in a network/contract management role, such as contracting, provider services, etc.
• 2+ years of experience in data analysis
• Demonstrated experience with making presentations to both small and large groups
• Intermediate proficiency with MS Suite (including Word, PowerPoint, and Excel)
• Access to reliable transportation and ability to travel up to 75% within Southern Idaho
• Ability to work evenings and weekends on occasion based on business needs
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

• 2+ years of project management or project lead experience
• 2+ years of experience working with claims systems
• 2+ years of experience with facility/ancillary contracts
• Expertise in physician/facility/ancillary contract reimbursement methodologies
• Understanding of medical financial statements and delivery systems, provider contracting, reimbursement arrangements, and network management
• Ability to manage multiple priorities and maintain an organized approach
• Established knowledge of local provider community
• Create business strategies through excellent analytical and problem solving skills with effective follow through
• Exceptional interpersonal skills with ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives, and other health plan staff

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer 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

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