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Provider Engagement Representative - Remote in Albuquerque, NM - 2232740

UnitedHealth Group

UnitedHealth Group

Albuquerque, NM, USA
Posted on Thursday, July 4, 2024

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Provider Engagement Representative (PER) will manage business relationships for contracted Skilled Nursing Facilities (SNF) for all UHC lines of business in Indiana, including working on end-to-end provider issues and call quality, and training & development of external provider education programs. The PER will conduct in-person meetings with Institutional Special Needs Plan (ISNP) facilities is critical to supporting the Senior Community Care (SCC) business to meet growth plans within the market.

The PER collaborates enterprise wide with other business units (Care Transitions, Optum Health) and provides support for Institutional and Institutional-Equivalent Special Needs Plan growth, affordability, and quality. This role facilitates and coordinates Business Review Meetings, Joint Operating Committee, and Provider Engagement Meetings for SCC.

If you are located within the Albuquerque, NM market, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

  • Develop and maintain overall UnitedHealthcare business relationships with Skilled Nursing Facilities & Assisted Living Facilities
  • Designs and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.) and business office managers
  • Direct and implement strategies relating to the development and management of a provider network
  • Support all education opportunities on UnitedHealthcare businesses which include in person and telephonic interactions
  • Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs
  • Lead and/or support external facing Account and business review meetings with key Skilled Nursing Facility staff to review financial performance, contract methodology, and reimbursement opportunities
  • Provide explanations and information to others on topics within area of expertise
  • Identify ancillary provider gaps, and support contracting of new providers in areas where needed
  • Prioritize and organize own work to meet deadlines cross functionally within the organization
  • Investigate non-standard requests and issues, prior to escalation if needed
  • Compass Data Base – update & maintain regularly with information following AR, Bus Review and JOC Meetings with facilities
  • Support Post-Acute Priorities
  • ISNP and Business Development – assist with planned growth initiatives for ISNP business
  • Education and Training to facilities on Medication Adherence requirements for members
  • Provide outreach and education on updated policies, new initiatives, performance, and others as necessary

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:

  • 2+ years of provider relations or provider network management experience
  • 1+ years of experience with Medicare/Medicaid regulations
  • Intermediate level of proficiency with MS Word, Excel, PowerPoint and, Outlook
  • Current resident of the state of NM and a valid NM driver’s license in good standing
  • Ability to travel 50% of the time within the Albuquerque, NM area

Preferred Qualifications:

  • Experience working in a Skilled Nursing or Assisted Living Facility
  • 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: 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.