Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)
ProHealth Physicians, part of OptumCare
If you want to get way ahead in your career, it makes sense to be with an organization that's way ahead of the curve. Formed in 1997, ProHealth Physicians has grown to become Connecticut’s leading primary care physician organization. With over 90 locations throughout the state of Connecticut, our family of primary care doctors and specialists care for more than 360,000 people statewide. In fact, ProHealth serves every county and provides roughly ten percent of the primary care delivered to patients in the state. We're leaders in thinking and in serving our communities. For instance, we're a C.M.S. approved Accountable Care Organization (ACO), covering over 30,000 Medicare patients associated with our community-based primary care providers. We're also nationally recognized as a NCQA Level III Medical Home. That kind of progressive leadership makes us perfect fit for OptumCare and UnitedHealth Group's expanding family of providers. This is a place where you can stay way ahead as you do your life's best work.SM
ProHealth Physicians is seeking a Provider Services Manager to join our team. This is primarily a remote position with 1 day a week in our Farmington office. The Provider Services Manager will be accountable for a full range of provider relations and service interactions within UHG, including working on 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 and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. 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. May also be involved in identifying and remediating operational short-falls and researching and remediating claims.
- Manage, mentor and evaluate staff with a focus on provider and practitioner quality, provider pricing, compliance with network requirements, department efficiency and department goals
- Communicate effectively and directly with internal and external customers at all levels within the organization
- Develop strong provider and practitioner relationships; assist in management of strategic vendor partner relationships
- Take responsibility for successful, quality and cost effective network solutions
- Collaborate and/or participate in discussions with colleagues and business partners to identify potential root cause of 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
- Involve leadership and/or escalate issues as necessary to implement provider solutions
- Ensure that provider solutions meet their needs and increase provider satisfaction (e.g., simplify processes)
- Communicate provider updates and information to applicable stakeholders (e.g., health plans; internal partners; providers; account managers; employer groups) 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
- Provide on-boarding and orientation to new providers (e.g., ensure providers take on-line training; provide instruction on processes for network participation)
- Develop resources and programs to assist and educate providers (e.g., web-based training; FAQ document)
- Work with internal groups and providers to identify, understand, and/or improve internal tools, resources, systems, and capabilities that can maximize provider, member, or company performance.
- Provide feedback to providers on quality and performance metrics/scorecards -Educate providers on policies and procedures applicable to delivery of care (e.g., regulatory; benefit; claims)
- Educate providers on administrative, clinical tools, processes and programs.
- Build/sustain effective relationships with providers to maintain open lines of communication and ensure our awareness of their needs
- Negotiate contractual rates and contract language with applicable providers
- Solicit provider informal and formal feedback via surveys, complaints and conversations in order to develop action plans (e.g., corrective actions; suggestions to leadership; complaint resolution process)
- Help providers understand and improve performance under incentive contracts and accountable care strategies
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.
- Bachelor’s Degree or equivalent experience
- Experience with Managed Care operations
- Network Management
- You will be asked to perform this role in an office setting or other company location
- Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
- Strong knowledge of the Payer field
- Project Management
- Knowledge of Claims processing & Prior Authorization
- Knowledge and understanding of value based arrangements
- Prior leadership experience developing and mentoring staff
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity 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: Network Provider, CT, Connecticut