Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
You know it. We know it. Change is sweeping through health care in ways that go beyond the basics covered in the news. People like you and organizations like UnitedHealth Group are driving ever higher levels of sophistication in how provider networks are composed and compensated. Everything is open to new ideas and innovation. And a lot of the good stuff starts in roles like this. Your expertise in provider networks can help us build in the next phase of evolution. In this 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 7 leader.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Help develop enterprise-wide Integrated Network teams that focus on specific pharmacy areas/service lines such as reporting or customer service
- Develop and distribute contract amendments, and collaborate with peers to develop contract language to meet evolving client needs and regulations
- Update OptumRx Provider Manual, and manage reviews and distribution of the manual
- Perform network analysis and strategy development and implementation
- Drive program design and implementation to improve quality and affordability through improvements in appropriateness and effectiveness
- Obtain, validate and analyze data as you analyze network availability and access
- Recommend utilization or expansion of networks for various products
- Ability to communicate with pharmacies regarding escalated issues
- Coordinate quarterly reports and awareness of contract language development
- Coach, provide feedback, and guide others
This is an opportunity that comes with great challenge. You'll be focused on value-based contracting for a particular health plan along with supporting the leading efforts of the business. This position will be focused on analysis, running reports, disbursement of checks to providers, organizing booklets or educational material and more.
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.
- Undergraduate degree or 3+ years of work experience
- 3+ years of experience with network data management in a managed care environment
- 3+ years of experience in provider data analysis
- 3+ years of experience with claims processing
- 2+ years of experience working with reporting tools and generating effective reports
- 2+ years of experience working in a fast-paced environment dealing with escalated issues
- 1+ years of experience drafting contracts (or equivalent legal education or experience)
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
- RX Claims experience
- Project management experience
- Excellent communication skills and relationship building skills
Building diverse, high quality provider networks is creating greater access to health care and improving the lives of millions. Join us. Learn more about how you can start doing your life's best work.(sm)
Careers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you’ll fill far more than prescriptions. As a member of one of our pharmacy teams, you’re empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)
Colorado Residents Only: The salary range for Colorado residents is $53,300 to $95,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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: Senior Network Program Specialist, Network Data Management, Data Analysis, Claims Processing, RX Claims, Provider Data, Managed Care, Project Management, Los Angeles, CA, California, United States, Work At Home, Remote, Work From Home, Telecommute, Telecommuter, Telecommuting