Associate Director, Network Programs - Ridgeland, MS

Unitedhealth Group Inc. Ridgeland , MS 39157

Posted 2 months ago

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)

This Community and State Network role is a key face of UHC to the provider community and the State Office of MS. The role is responsible for provider engagement and satisfaction, as well as ensuring the network meets regulatory requirements. The business is primarily Medicaid (CHIP and MSCAN), but also includes other products such as DSNP. The role serves as the plan's contact with the State office of Mississippi. The role is the primary liaison with Corporate on all issues related to network programs and provider relations.

Primary Responsibilities:

  • Assists in relationship building and management of key providers; participates in Provider Advisory Council meetings

  • Hosts or attends forums designed to create engagement and partnership at all levels of health care delivery and promote UHC as a key player in this market

  • Participates in Tier 1 hospital Joint Operating Committees

  • Engages in Provider relations strategy meetings

  • Ensures information is communicated downstream to enable network partners to deliver appropriate C&S messages to providers

  • Drafts correspondence to providers related to changes, new policies, programs, products, etc.

  • Oversees provider related issues resolution as needed working with State of MS Medicaid or Department Of Health (DOH)

  • Ensures compliant policies and procedures

  • Oversees any Corrective Action Plan (CAP) reviews and ensures communication with providers

  • Reviews fee schedule increase requests / justification and with Director, determine which go to Finance for impact analysis; Conduct final review and make determinations about fee increases to key providers

  • Review payment methodologies / fee schedules and make recommendations for change to better align with goals and objectives

  • Works with others to conduct joint delegate oversight activities of Network Operations

This position is office based in Ridgeland, MS.

This is an opportunity that will offer you challenge like no other. We operate a complex, matrixed business that requires you to work through ambiguity even as you build a relationship with some of our most focused and intense business leaders. You'll need to conceptualize effectively, communicate clearly and earn credibility within a demanding business environment.

Required Qualifications:

  • 5 years of experience working with a managed care organization, health insurer, or consultant in a network management / contract management role, such as contracting, provider services, etc.

  • 3 years of experience in data analysis

  • 3 years of project management or project lead experience

  • 3 years of presentation development and delivery experience

  • Proficiency in MS Office (Excel and PowerPoint)

Preferred Qualifications:

  • Undergraduate or higher level degree

  • 3 years of experience with operations (claims, etc.)

  • 3 years of experience with contract submission, validation and maintenance

  • 5 years of experience managing staff

  • Work experience demonstrating ability to develop positive working relationships with providers

  • Intermediate level of proficiency with all facility / ancillary contract reimbursement methodologies

  • Experience working with Medicaid or Medicare Products

  • Experience working with providers in the state of MS

  • Strong knowledge of business processes that impact facility / ancillary contact loading and auditing

  • Ability to convey complex or technical information effectively

  • Excellent communication skills, verbal and written and with diverse levels of leadership

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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

Job Keywords: Associate Director, Network Programs, Associate Director, Provider Engagement, Associate Director, UHC contact with State of MS, UHC Relationship Manager to state of MS, Ridgeland, Jackson, Madison, Brandon, Pearl, MS, Mississippi

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Associate Director, Network Programs - Ridgeland, MS

Unitedhealth Group Inc.