Manager Network Contractor - Miami, FL - Bilingual Spanish Required

UnitedHealth Group•Miami, FL

6d•$91,700 - $163,700•Hybrid

About The Position

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. Must be a FL resident as position requires 25%25 to 50%25 travel in region. The C&S Long Term Care Division requires this position for servicing the LTC provider network, to include provider contracting, credentialing and re-credentialing, conducting provider relations tasks, providing education, working in the provider portal and EVV (electronic visit verification), providing assistance with claims, ensuring network adequacy and closing gaps where necessary, along with network tracking and reporting. This role works with the case management staff to assist with network needs for member benefits and services, to include working Single Case Agreements (SCAs) and Provider Network Requests (PNRs). Description The Manager of Network Contracting serves in the capacity of Managing the Florida SMMC Long Term Care (LTC) provider network. This position will develop and maintain the Home and Community Based (HCBS) ancillary providers, yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management and produces an affordable and predictable product for customers and business partners. This role will lead a team of SR Provider Advocates, overseeing network functions such as managing and maintaining solid business relationships with providers, and ensuring the network composition includes an appropriate distribution of Long-Term Care (LTC), Home & Community Based (HCBS) specialties. Additional Job Information: This position will be located in Florida. The goals of our LTC network team are to manage and carry out the provider network requirements for the Health Plan with the State regulator. Provider Relations, Network and Contracting experience is a must, Microsoft Excel intermediate to advanced level is required due to the needs of network reporting. Microsoft Access basics is a plus. If you live in FL, you will have the flexibility to work remotely as you take on some tough challenges. This position requires 25-50%25 travel in region

Requirements

5+ years working in a network management-related role, contracting, provider services
5+ years working with provider/group Medicaid/Long Term Care contracts, claims, credentialing
3+ years of experience in ancillary/facility/group credentialing, to include knowledge of credentialing requirements for the State of Florida
3+ years of experience in performing network adequacy analysis
Experience working with Long Term Care provider specialties (Assisted Living Facilities, Adult Day Care, Adult Family Care Home, Home Health Care, Nurse Registry, Homemaker Companion, and Atypical provider types)
Intermediate to advanced level of knowledge of Medicaid and Long Term Care reimbursement methodologies
Intermediate to advanced level in Microsoft Word, Excel, PowerPoint, Access
Advanced skill set in data management and manipulation
Proven excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
Proven solid interpersonal skills, establishing rapport and working well with others
Driver’s License and access to a reliable transportation
Bilingual Spanish Required

Nice To Haves

Microsoft Access basics is a plus
English-Spanish bilingual

Responsibilities

Manages and is accountable for professional employees
Impact of work is most often at the local level
Sets team direction, resolves problems and provides guidance to members of own team
May oversee work activities of other tea members
Adapts departmental plans and priorities to address business and operational challenges
Influences or provides input to forecasting and planning activities
Product, service or process decisions are most likely to impact multiple groups of employees and/or customers (internal or external)
Demonstrate expertise in provider network functions, ability to work in a fast-paced environment
Ability to take initiative and use problem-solving skills for issue resolution
Work independently with little need for instruction, guidance or direction
Must be attentive to detail, work with flexibility, and have the capability of multi-tasking to meet deadlines and deliverables
Possess knowledge in Medicaid and Long Term Care (Home and Community Based) programs
Experience working with Health Plan contracts in compliance with company contract templates to ensure the network composition includes an appropriate distribution of provider specialties
Display professional work ethics in a structured work environment
Team environment aptitude, work in partnership with Sr Provider Relations Advocates and interact well with staff in cross-segment departments
Perform other duties as required
Servicing the LTC provider network, to include provider contracting, credentialing and re-credentialing, conducting provider relations tasks, providing education, working in the provider portal and EVV (electronic visit verification), providing assistance with claims, ensuring network adequacy and closing gaps where necessary, along with network tracking and reporting.
Works with the case management staff to assist with network needs for member benefits and services, to include working Single Case Agreements (SCAs) and Provider Network Requests (PNRs).
Develop and maintain the Home and Community Based (HCBS) ancillary providers, yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management and produces an affordable and predictable product for customers and business partners.
Lead a team of SR Provider Advocates, overseeing network functions such as managing and maintaining solid business relationships with providers, and ensuring the network composition includes an appropriate distribution of Long-Term Care (LTC), Home & Community Based (HCBS) specialties.