Out of Network Dispute Manager

UnitedHealth Group•Tampa, FL

1d•$72,800 - $130,000•Remote

About The Position

This position is National Remote. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. 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. You'll join a high caliber team where you're assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength and attention to detail. In return we offer the latest tools and most intensive training program in the industry. Get ready to start doing your life's best work. The Out of Network (OON) Dispute Resolution team is responsible for end to end resolution of regulated OON disputes/arbitrations across UHC commercial lines of business on a variety of platforms. This team has expanded significantly as a result of the No Surprises Act section of the federal Consolidated Appropriations Act. As a key member of the OON Dispute Resolution Team, the business manager is responsible for the day to day functions of UHC’s mediation programs which are mandated by state and federal statutes. The manager is also responsible for the development and implementation of process changes due to strategic initiative shifts or regulatory requirements. This position requires extensive verbal and written communication with internal partners as well as regulators, arbitrators, and provider representatives. The manager collaborates across functions to develop strategy related to: -Network/OON Programs -Health Care Economics -Legal, Compliance and Regulatory Affairs (LCRA) -Regulatory Implementation

Requirements

High School Diploma / GED OR equivalent work experience
Must be 18 years of age OR older
3+ years of managerial OR equivalent experience leading a team through coaching, mentoring, and providing feedback
2+ years of experience facilitating cross functional teams through process and business changes
2+ years of experience utilizing data to influence key decision makers
2+ years of experience driving best practices / actions related to quality, productivity and consumer experience
Demonstrate and apply understanding of UnitedHealth Group’s business (e.g. specific business capabilities, functions, processes and business cycles)
Intermediate level of proficiency utilizing Microsoft Excel (formulas, pivot tables), Microsoft Word (create and edit documents) Microsoft PowerPoint (create and edit presentations)
Ability to work full time. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00am - 5:00pm.
Ability to keep all company sensitive documents secure (if applicable)
Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Responsibilities

Sets team direction, resolves problems and provides guidance to team members
Oversees work activities of Supervisors, Subject Matter Experts, Team Leads, Negotiation Analysts, and global and domestic OON Dispute Analysts
Implements departmental plans and priorities to address business and operational challenges
Influences or provides input to forecasting and planning activities
Responsible to maintain existing policies, procedures and best practices of the program
Implement process and policy revisions as needed to ensure continued compliance with applicable laws and regulations
Execute implementation changes in support of state and federal surprise billing requirements
Analyze, Manage and Communicate Regulatory Information
Perform critical and objective review of regulatory information (e.g., obtain/interpret/analyze impact on the business)
Determine whether business processes are consistent/compliant with applicable regulatory requirements, and take appropriate action as needed (e.g., coordinate with business functions, complete applicable filings/attestations)
Collaborate with business partners to review, analyze and oversee/coordinate applicable implementation project plans from a regulatory perspective
Manage/monitor implementation to ensure that corrective actions and compliance plans are properly implemented, in collaboration with applicable business partners (e.g., Compliance, functional areas)
Utilize appropriate tools and processes to track regulatory compliance (e.g., metrics, advocacy results, fines, legal findings)
Collaborate with applicable stakeholders to analyze arbitration results, identify needed process modifications, recommend adjustments to strategy
Develop/manage relationships with internal and external stakeholders to maintain ongoing influence on regulated Out of Network disputes
Advocate with internal business partners to drive compliance with established laws/regulations
Negotiate with regulators on a variety of regulatory matters (e.g., fines, corrective actions)
Collaborate with internal business partners to drive achievement of regulators' expectations
Demonstrate Understanding of Applicable Business Strategies, Structures, Processes and Regulatory Requirements
Navigate/collaborate effectively across the business/segment in a matrix environment, identifying and leveraging key contacts
Leverage applicable tools and resources to obtain and store required business data/ information (e.g., intranet, SharePoints, websites, regulatory tracking tools)
Demonstrate understanding of the health care industry and marketplace (e.g., competitors, product offerings/types, political environment)
Monitor trends in the healthcare industry and identify implications on regulatory matters pertaining to regulated Out of Network disputes
Maintain awareness of current and emerging trends/changes in the regulated Out of Network disputes environment
Provide ongoing support/consulting/guidance to business partners to drive compliance with applicable laws and regulations
Identify business risks related to regulatory matters, and escalate/communicate as necessary
Manage/consult on regulated Out of Network disputes