We all agree that health care can perform better if we continue to challenge the status quo. Right? That's why people like you and organizations like UnitedHealth Group are driving ever higher levels of sophistication in how provider networks are composed and compensated. Your expertise in provider networks can help us build in the next phase of evolution. In this managerial role, you'll use your knowledge and analytical skills to help determine how clinical providers group up by specialty and service line. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 6 leader.
The Manager, Contracted Network Services is responsible for assisting central and market leadership in the development of a high performing contracted network, ensures CMS adequacy levels are maintained in developed markets, and performs research, data analysis, and tools to drive strategy and decision making and prioritization in emerging and mature markets. As the Manager, Contracted Network Service the position will oversee Contracted Network Service Representatives and be responsible for communicating, identifying Subject Matter Experts to solve issues, and managing the follow-through to ensure credentialing, system access requirements, provider directories, member assignment, and other related operational information is accurately reflected in the applicable data capturing and reporting systems for providers in the contracted markets. This position will have a strong working knowledge of the healthcare delivery organization, the operational levers that contribute to a high performing network, and identify opportunities to close gaps. This position is expected to build and sustain strong working relationships with cross functional departments both internal and external, vendors, local and central leadership, and providers.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Researches, keeps up to date, and communicates compliant network requirements to management and stakeholders
- Develops the tools necessary to maintain accurate records on network requirements, gaps and plans to sustain compliance
- Performs research utilizing corporate resources, government publications (ex. CMS.gov), industry publications, subscription databases, etc. to provide insight and regulatory guidelines pertaining to network requirements and emerging market trends
- Develops original material and assists management in delivering key messages to internal and external stakeholders as required
- Plays key role in the creation and execution of local network development plans to assure an adequate and high performing contracted network
- Demonstrates the ability to understand performance results and key drivers that impact results
- Works at the direction of their assigned leader to recruit/contract providers to build the networks in alignment with the overall growth strategy
- Conducts detailed analysis of various performance and trending data to identify opportunities to improve network construction and appropriately tier providers
- Assists as needed with new provider orientations and collaborates with Physician Business Managers on ongoing education to providers and their staff on healthcare delivery products, health plan partnerships and compensation arrangements
- Participates as required in various department, leadership, or cross-functional meetings
- Collaborates, communicates, and manages to conclusion in conjunction with the Physician Business Managers data integrity matters for providers including but not limited to: complete Practitioner Data Forms, Provider Change Forms, membership attribution, Credentialing status, provider directories, system access, and other operational questions as needed
- Performs all other related duties as assigned
- Assists in aligning people and projects to achieve initiatives
- Works with direct reports to develop goals and objectives
- Works with direct reports to establish performance standards for work assignments, monitors work status and progress including goals and objectives
- Values cultural diversity and other individual differences in the workforce, ensuring that the organization builds on these differences
- Ensures employees are treated in a fair and equitable manner
- Complies with all EEO obligations and responsibilities
- Develops staff through coaching, mentoring, rewarding, training, and guiding
- Empowers employees and recognizes and rewards their contributions
- Surrounds self with highly capable people. Assists in managing employee issues and resolving grievances
- Assists to interview, hire, and orient direct reports
- Assists in completing performance evaluations for direct reports on a timely basis
- Notifies Manager or Executive Director of possible employee performance or behavior problems, may assist in disciplinary or termination process
- Assists all staff in the interpretation of policies and procedures
- Assesses current and future staffing needs based on organizational goals
- Utilizes compensation data provided by Human Resources
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.