Requisition number: 2393407

Job category: Network Management

Optum Serve Health Services (OSHS) is one of three businesses under Optum Serve . Optum Serve provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well-being of Americans. By joining Optum Serve you are part of the family of companies that makes UnitedHealth Group a leader across most major segments in the U.S. health care system.

OSHS specializes in creating and managing health care programs through on-location services, patient specific in-clinic appointments, telehealth assessments, or any combination based on customer need. OSHS's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.

The National Provider Relations Advocate is accountable for the full range of provider relations and service interactions within Optum Serve, including working on end-to-end provider claims / concerns, ease of use of provider portal, and support for training & development of external provider education programs. They will support and nurture positive relationships between Optum Serve, providers, and program managers. Supports strategies relating to the retention of the provider network. May also be involved in identifying and remediating operational short-falls and researching and remediating claims.

Schedule: Full-time, 40-hour work week, Monday through Friday, Employees work 8-hour shifts, with a flexible schedule determined by the supervisor upon hire.

Location: Remote nationwide ( 10% sites visits to ensure compliance 50 to 100 miles from their home.)

Primary Responsibilities:

• Provide on-boarding and orientation to new providers (e.g., ensure providers take on-line training; provide instruction on processes for network participation)

• Participate in company initiatives related to compliance or advocating company resources

• Apply knowledge of applicable health care industry practices, trends and issues to inform communications about how our products/services can benefit providers

• Communicate and advocate providers' needs to internal stakeholders in order to drive creation of solutions that meet our mutual business goals

• Develop resources and programs to assist and educate providers (e.g., web-based training; FAQ document)

• Work with internal groups to identify, understand, and/or improve internal tools, resources, systems, and capabilities that can maximize provider, member, or company performance

• Assess provider understanding and needs related to industry and company information, tools, systems, and changes

• Communicate industry and company information to providers through various means (e.g., newsletters; emails; outreach calls; teleconference; conferences; on-site meetings)

• Provide feedback to providers on quality and performance metrics/scorecards

• Educate providers on policies and procedures applicable to delivery of care (e.g., regulatory; benefit; claims)

• Educate providers on administrative tools (e.g., portal; electronic payments and statements; Intellijet; IVR)

• Educate providers on clinical tools, processes, and programs (e.g., utilization review; wellness assessments; quality/gaps in care; Premium Designation; View360; UM Template)

• Gather data from relevant systems (e.g., claims; data warehouse; payment integrity; EDI/Portal reporting; customer relations systems) and business partners (e.g., contracting; claims operations)

• Collaborate and/or participate in discussions with colleagues to identify potential root cause of issues

• Demonstrate understanding of providers' business goals and strategies in order to facilitate the analysis and resolution of their issues

• 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

• Involve leadership and/or escalate issues as necessary to implement provider solutions

• Coordinate with internal and/or external resources to implement provider solutions

• Ensure that provider solutions meet their needs and increase provider satisfaction (e.g., simplify processes)

• Analyze network adequacy based on defined access standards, target markets, or customer requirements to identify need to recruit new provider

• Perform network analysis to identify potential provider recruitment opportunities (e.g., review competitive data; review Board Certified website)

• Research provider nominations or recruitment requests (e.g., from members, sales, account management) in order to achieve network adequacy

• Summarize and communicate provider network outcomes (e.g., recruitment and/or retention) to internal and external stakeholders

• Build/sustain effective relationships with providers to maintain open lines of communication and ensure our awareness of their needs

• Make updates to provider information (e.g., address changes; location changes; specialty changes)

• Support recruiting and retention efforts by identifying and/or implementing improvement/expansion opportunities to provider services

• Respond to provider's requests by directing them to appropriate internal or external resources

• Help providers understand and improve performance under incentive contracts and accountable care strategies

• Communicate provider updates and information to applicable stakeholders (e.g., health plans; internal partners; providers; account managers; employer groups) regarding research and resolution of issues within applicable defined metrics (e.g., turnaround time)

• Ensure that provider data (e.g., demographics; fee schedule) is accurate through audits, re-credentialing, and/or outreach

• Review and respond to provider complaints in a timely fashion

• Performs other duties as assigned

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays

• Medical Plan options along with participation in a Health Spending Account or a Health Saving account

• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage

• 401(k) Savings Plan, Employee Stock Purchase Plan

• Education Reimbursement

• Employee Discounts

• Employee Assistance Program

• Employee Referral Bonus Program

• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

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:

• High School Diploma

• 1+ years of experience in provider relations

• 1+ years of customer service or healthcare experience

• Intermediate computer proficiency experience with Microsoft Office (Word, Excel, and Outlook) and be able to access multiple web applications

• Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)

• Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications:

• Ability to travel 10% of the time within 100 miles of territory assigned and Reliable transportation, with a current and non-restricted state Driver's License and State-required insurance

• Provider data loading or other healthcare database maintenance

• Proficiency with MS Access, MS Visio, and/or MS SharePoint

• Experience in continuous process, efficiency, and quality improvement

• 2+ years of data entry experience

Soft Skills:

• Ability to work independently and maintain good judgment and accountability

• Demonstrated ability to work well with health care providers

• Strong organizational and time management skills

• Ability to multi-task and prioritize tasks to meet all deadlines

• Ability to work well under pressure in a fast-paced environment

• Ability to problem-solve complex problems

• Ability to work collaboratively with internal\external team as well as providers

• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others

*All Telecommuters 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 hourly pay for this role will range from $24.00 to $43.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

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.

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

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