Must be a FL resident as position requires 25% to 50% travel in region.The C&S Long Term Care Division requires this position for servicing the LTC provider network, to include provider contracting, credentialing and re-credentialing, conducting provider relations tasks, providing education, working in the provider portal and EVV (electronic visit verification), providing assistance with claims, ensuring network adequacy and closing gaps where necessary, along with network tracking and reporting. This role works with the case management staff to assist with network needs for member benefits and services, to include working Single Case Agreements (SCAs) and Provider Network Requests (PNRs).
DescriptionThe Manager of Network Contracting serves in the capacity of Managing the Florida SMMC Long Term Care (LTC) provider network. This position will develop and maintain the Home and Community Based (HCBS) ancillary providers, yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management and produces an affordable and predictable product for customers and business partners. This role will lead a team of SR Provider Advocates, overseeing network functions such as managing and maintaining solid business relationships with providers, and ensuring the network composition includes an appropriate distribution of Long-Term Care (LTC), Home & Community Based (HCBS) specialties.
Additional Job Information:This position will be located in Florida. The goals of our LTC network team are to manage and carry out the provider network requirements for the Health Plan with the State regulator. Provider Relations, Network and Contracting experience is a must, Microsoft Excel intermediate to advanced level is required due to the needs of network reporting. Microsoft Access basics is a plus.
If you live in FL, you will have the flexibility to work remotely* as you take on some tough challenges. This position requires 25-50% travel in region
Primary Responsibilities:- Job Scope and Guidelines:
- Manages and is accountable for professional employees
- Impact of work is most often at the local level
- Sets team direction, resolves problems and provides guidance to members of own team
- May oversee work activities of other tea members
- Adapts departmental plans and priorities to address business and operational challenges
- Influences or provides input to forecasting and planning activities
- Product, service or process decisions are most likely to impact multiple groups of employees and/or customers (internal or external)
- In this role you will be expected to:
- Demonstrate expertise in provider network functions, ability to work in a fast-paced environment
- Ability to take initiative and use problem-solving skills for issue resolution
- Work independently with little need for instruction, guidance or direction
- Must be attentive to detail, work with flexibility, and have the capability of multi-tasking to meet deadlines and deliverables
- Possess knowledge in Medicaid and Long Term Care (Home and Community Based) programs
- Experience working with Health Plan contracts in compliance with company contract templates to ensure the network composition includes an appropriate distribution of provider specialties
- Display professional work ethics in a structured work environment
- Team environment aptitude, work in partnership with Sr Provider Relations Advocates and interact well with staff in cross-segment departments
- Perform other duties as required
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.
Required Qualifications:- 5+ years working in a network management-related role, contracting, provider services
- 5+ years working with provider/group Medicaid/Long Term Care contracts, claims, credentialing
- 3+ years of experience in ancillary/facility/group credentialing, to include knowledge of credentialing requirements for the State of Florida
- 3+ years of experience in performing network adequacy analysis
- Experience working with Long Term Care provider specialties (Assisted Living Facilities, Adult Day Care, Adult Family Care Home, Home Health Care, Nurse Registry, Homemaker Companion, and Atypical provider types)
- Intermediate to advanced level of knowledge of Medicaid and Long Term Care reimbursement methodologies
- Intermediate to advanced level in Microsoft Word, Excel, PowerPoint, Access
- Advanced skill set in data management and manipulation
- Proven excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
- Proven solid interpersonal skills, establishing rapport and working well with others
- Driver's License and access to a reliable transportation
Preferred Qualification: - English-Spanish bilingual
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
