Network Director, Remote in Idaho

UnitedHealth Group•Boise, ID

5d•$112,700 - $193,200•Remote

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 The Network Director is responsible for the full range of provider engagement and adequacy strategies. The Network Director will design and implement programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. This role will oversee and seek to improve and simplify end-to-end provider experience including service interactions, appeals and complaints, and general relationship status. Position in this function responsibilities also include directing and implementing strategies relating to the management of a provider network, identifying gaps in network composition and services to assist the network contracting. This may also include identifying and remediating operational short-falls and researching and remediating claims. The Network Director will spend time connecting with providers directly, both virtually and in person, and assimilating and analyzing data to gain better visibility into provider experience. This is a fast-paced working environment that requires the ability to multitask with attention to detail and excellent organizational skills. This is an Idaho-based position, and you will have the flexibility to work remotely as you take on this challenging and rewarding work. If you are located in Idaho, you will have the flexibility to work remotely as you take on some tough challenges.

Requirements

5+ years of Provider Network Relationship Experience
4+ years of Medicaid and/or Medicare Experience
4+ years of experience managing multiple projects
4+ years of experience with direct communication with Regulators
Understanding of Medicaid contracting process, including downstream agreements
Intermediate level of proficiency with MS Word, Excel, and PowerPoint
Proven ability to establish and monitor key performance indicators
Proven ability to meet deadlines
Proven ability to influence course of action when other teams are directly accountable for outcomes
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Nice To Haves

Experience with Compliance Audits
Proven excellent organizational skills
Proven reporting techniques (SQL, PowerBI, etc.)

Responsibilities

Manage provider complaints to resolution when initiated through regulators. Report status updates to IDHW and providers, as needed. Implement solutions that educate network on how to resolve issues with UHC resources
Proactively partner with providers to identify opportunities for improvement, opportunities for growth and collaboration, and to gain general feedback regarding provider experience
Partner with the COO to investigate and solve operational challenges. Report status updates to IDHW and providers, as needed. Maintain consultative and collaborative approach with providers through resolution
Engage in onsite visits with providers. Utilize data analysis to determine the best strategy to choose which providers should be visited. Factors may include complaints, claim volume, attribution, quality measures, overlap with other teams, etc.
Manage regulatory reports for the Idaho network. Partner with technical and functional teams to compile and audit reports
Manage HCBS Provider Advocates (2), Workforce Development Administrator, Credentialing Coordinator, and Provider Claims Educator, which includes coaching, mentorship, collaboration, auditing and monitoring, establishing development and career planning, and more
At least monthly, facilitate meetings with all provider-facing teams including, but not limited to provider relations, network contracting, growth, quality, and subcontractor provider teams
Attend key provider conferences
Show leadership with subcontractors who manage provider networks, including dental and vision
Lead and facilitate meetings with providers and provider groups including IHA and other provider meetings where regulators are present. Attend and contribute to other virtual provider meetings
Attend assigned advisory committees and contribute to the conversation showing leadership and subject matter expertise about our provider experience
Partner with other provider teams to build expertise and relationships including credentialing, contracting, provider education, etc.
Partner with providers in the adoption of enterprise tools that reduce administration, including but not limited to POCA (Point of Care Authorizations)
Monitor Provider NPS with a focus on improvement
Oversee provider communications, including the following: Manage annual update and publication of provider manual, Participate in quarterly provider newsletter production, Conduct provider website review monthly and partner with web teams for updates as needed
Attend Call Calibration sessions to better understand provider experience and provide coaching and guidance to customer service team to improve the experience
Be a subject matter expert regarding contract obligations relating to network
Meet with IDHW and other regulatory points of contact, as needed. Focus on relationship building, maintaining awareness and transparency, and making progress
Consistently monitor network adequacy through Geo-Access reports and partner with UHN and other network teams to fill network gaps
Partner with Member Engagement Coordinator to solicit member feedback around provider experience and network gaps
Partner with the SDoH Navigator and Population health team to drive Health Equity initiatives and SDoH goals within the network of providers
Partner with UHC and other functional areas on Value Based Contracting opportunities and execution
Represent UHC in in-person provider meetings, IDHW Provider Forums, and other Provider Related conferences, which will require the ability to travel within ID at least 25%25 of the time