RI Network Program Consultant Telecommute in Northeastern U.S

Company: United healthcare Group
Location: Warwick
Posted on: September 16, 2020

Job Description:

UnitedHealthcare 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. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) The Network Program Consultant is responsible for the oversight and monitoring of key network program processes to ensure contract compliance with regulatory requirements. This includes management of the following contractual requirements; provider roster management and reconciliation in support of the Medicaid Accountable Entity (AE) program, provider attribution logic management, and Federally Qualified Health Center (FQHC) wrap payment process management. The Network Program Consultant will perform data analysis, reporting and ongoing monitoring and coordination with cross functional teams to ensure compliance of these processes. Other responsibilities include supporting the health plan with cross-functional project management to coordinate the development and maintenance of on-going requirements (i.e. network / operational reporting, member / provider materials, etc.). This position will be both internal and external facing, collaborates with chief operating officer, network programs and strategy director, AE program manager, health plan operational leads, finance / healthcare economics, United Health Networks teams and other internal shared services teams as appropriate. You'll enjoy the flexibility to telecommute* from anywhere within the Northeastern States as you take on some tough challenges. Primary Responsibilities: * Ensure appropriate metrics and controls are in place to ensure compliance with program requirements * Serve as a key resource on complex and/or critical issues * Solve complex problems and develop innovative solutions * Perform complex conceptual analyses * Review work performed by others and provide recommendations for improvement * May lead functional or segment teams or projects * Provide explanations and information to others on the most complex issues * Motivate and inspire other team members This candidate must have strong analytical skills as well as strong working knowledge of data manipulation with Excel and/or Access. Working knowledge of UnitedHealthcare systems and workflows is highly desired. This candidate needs to be a self-starter and work independently once provided directions. 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: * Undergraduate degree or equivalent job experience * 3+ years of experience in health care operations, products and benefits, claims processing, provider data maintenance, contracting, or contract loading * 3+ years of experience with contract submission, validation and maintenance * 3+ years of Project Management experience with the ability to multitask, coordinate and keep multiple projects simultaneously on track * Experience translating program objectives into action plans and influencing teams to execute effectively with flexibility to adapt and change direction as needed * Demonstrated ability to work in cross-functional capacity and navigate matrix organization * Intermediate level of proficiency with provider contract reimbursement methodologies (professional, ancillary, facility) * Strong knowledge of business processes that impact provider contact loading and auditing * Advanced proficiency in Excel and PowerPoint Preferred Qualifications: * Accountable Care Organizations and Value Based Model / Contracting experience * Network experience within a healthcare environment * Experience in local markets (RI, MA, CT) * Experience with Access * Medicaid and Medicare knowledge * Solid understanding of UHC operations, network, products and benefits * Emerging leadership presence, with ability to manage prioritization of programs, effectively communicate strategy to attain goals, and challenge thinking * Excellent communication skills required including ability to communicate and present ideas and tactics effectively with various levels of leadership within internal and external settings * Ability to travel within the local markets up to 25% Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 7 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm) *All Telecommuters will be required to adhere to UnitedHealth Group's 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. Job Keywords: RI Network Program Consultant, Claims Processing, Provider Data Maintenance, Contracting, Contract Loading, Contract Reimbursement Methodology, Network Management, Network Program Consultant, Network Manager, Provider Data Operations, Project Management, Telecommute, Telecommuting, Telecommuter, Work From Home, Remote, Warwick, RI, Rhode Island, Hartford, Shelton, CT, Connecticut, Boston, Worcester, MA, Massachusetts, New York, NY Job Details * Requisition Number * Job Title RI Network Program Consultant - Telecommute in Northeastern U.S. * Job Family Network Management * Business Segment Community and State Job Location Information * Warwick, RI United States North America * Other Locations Hartford, CT New York, NY Boston, MA Worcester, MA New York, NY Additional Job Detail Information * Employee Status Regular * Schedule Full-time * Job Level Individual Contributor * Shift Day Job * Travel No * Telecommuter Position Yes * Overtime Status Exempt

Keywords: United healthcare Group, Warwick , RI Network Program Consultant Telecommute in Northeastern U.S, Professions , Warwick, Rhode Island