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RichmondReston, VA
United States
Customer Service
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Associate Network Director VA Medicaid Program - Richmond, VA

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm) The Associate Network Director of VA Medicaid Programs will manage and coordinate the Provider Network activities necessary to support the Medicaid client base. The coordination will occur across hospitals, physicians, dental, ancillary and behavioral health networks. Examples include coordinating provider relations activities, analyzing provider performance, assist with provider reimbursement arrangements, and credentialing activities.  The individual will be available to assist with state of VA Network requests and/ to coordinate and meet state submission requirements enabling resolutions to support the Medicaid population   Primary Responsibilities: Engaged in the full range of provider relations and service interactions within UHG, including assisting with end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training & development of external provider education programs Designs & recommends programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, UBH, PT etc.), and practice managers.  As approved, directs and implements strategies relating to the development and management of a provider network Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs Coordinate and assist in preparation of the C & S network strategy business plans for VA including Value Based Contracting Strategy Assist in development and approval of VA C&S Provider Network Policies & Procedures Provide a provider tracking tool of key VA C&S provider negotiations, terminations Assist in coordinating UHN activities with Vendors, such as OPTUM ( UBH, PT, etc.) to ensure they are providing the support levels required Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities Identifies and resolves technical, operational and organizational problems outside own team Gathers data from relevant systems (e.g., claims; data warehouse; payment integrity; EDI/Portal reporting; customer relations systems) and business partners (e.g., contracting; claims operations) Collaborate and / or participate in discussions with colleagues and business partners to identify potential root cause of issues Demonstrate understanding of providers' business goals and strategies as offered by Network Management in order to facilitate the analysis and resolution of their issues Analyze data to determine root cause of issue (e.g., identify trends and patterns; identify outliers and anomalies) and / or escalate problem to appropriate group for further analysis as necessary Work with relevant internal stakeholders to identify obstacles and barriers identified by providers, and methods for removing them Work with relevant internal stakeholders to develop solutions to underlying problems / issues identified by providers Involve leadership and / or escalate issues as necessary to implement provider solutions Coordinate with internal and / or external resources to implement provider solutions Assist via provider solutions in meeting their needs and increase provider satisfaction (e.g., simplify processes) Communicate provider updates and information to applicable stakeholders (e.g., health plans; internal partners; account managers;) regarding research and resolution of issues within applicable defined metrics (e.g., turnaround time) Ensure that provider data (e.g., demographics; fee schedule) is accurate through audits, re-credentialing, and / or outreach Participate in company initiatives related to compliance or advocating company resources Apply knowledge of applicable health care industry practices, trends and issues to inform communications about how our products / services can benefit providers Communicate and advocate providers' needs to internal stakeholders in order to drive creation of solutions that meet our mutual business goals Develop resources and programs to assist and educate providers through network management (e.g., web-based training; FAQ document) Work with internal groups to identify, understand, and / or improve internal tools, resources, systems, and capabilities that can maximize provider, member, or company performance Assess provider understanding and needs related to industry and company information, tools, systems, and changes Assist as requested with Communicating industry and company information for providers through various means (e.g., newsletters; emails; outreach calls; teleconference; conferences; on - site meetings) as approved by Network Management Provide feedback to providers on quality and performance metrics / scorecards Assist Network Management on educating providers on policies and procedures applicable to delivery of care (e.g., regulatory; benefit; claims) and administrative tools (e.g., portal; electronic payments and statements; IntelliJet; IVR) Assist Network Management on educating providers on clinical tools, processes, and programs (e.g., utilization review; wellness assessments; quality / gaps in care Analyze network adequacy based on defined access standards, target markets, or customer requirements to identify need to recruit new provider Perform network analysis to identify potential provider recruitment opportunities (e.g., review competitive data; review Board Certified website) Research provider nominations or recruitment requests (e.g., from members, sales, account management) in order to achieve network adequacy Conduct recruitment activities (e.g., mailings; calls; follow-up documentation) with targeted providers to solicit participation Summarize and communicate provider network outcomes (e.g., recruitment and / or retention) to internal and external stakeholders  Required Qualifications: Undergraduate degree or equivalent experience 7+ years of provider relations and / or network management experience 5+ years of management experience Expert level of knowledge of claims / systems processes, contracting and reimbursement methodologies 5+ years of experience with Medicare and Medicaid regulations Preferred Qualifications: Exceptional presentation, written and verbal communication skills Ability to work independently and remain on task Good organization and planning skills Ability to prioritize and meet deadlines from multi - staff members within the department Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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: provider relations,  network management, claims / systems processes, contracting and reimbursement methodologies, Medicare and Medicaid regulations, Richmond VA, Reston, VA, Virginia

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