Provider Engagement Representative-Remote

UnitedHealth Group•Hartford, CT

1d•Remote

About The Position

Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs — helping patients access and navigate care anytime and anywhere. As a team member of our Senior Community Care (SCC) team, we work to provide care to patients at home, nursing homes and assisted living for senior housing. This life-changing work adds a layer of support to improve access to care. We’re connecting care to create a seamless health journey for patients across settings. 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. This position will be remote with travel within the CT / Rhode Island market.

Requirements

2+ years of provider relations or provider network management experience
1+ year of experience with Medicare/Medicaid regulations
Intermediate level of proficiency with MS Word, Excel, PowerPoint and, Outlook
Driver’s License and access to a reliable transportation
Ability to travel 25%25 of the time within the CT area

Nice To Haves

Experience working in a Skilled Nursing or Assisted Living Facility
Ability to prioritize and meet deadlines
Familiarity with claims processing and issue resolution

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 IE-SNP Business Development - assist with planned growth initiatives for ISNP/IE-SNP 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