The Network Director is responsible for the full range of provider engagement and adequacy strategies. The Network Director will design and implement programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. This role will oversee and seek to improve and simplify end-to-end provider experience including service interactions, appeals and complaints, and general relationship status.
Position in this function responsibilities also include directing and implementing strategies relating to the management of a provider network, identifying gaps in network composition and services to assist the network contracting. This may also include identifying and remediating operational short-falls and researching and remediating claims. The Network Director will spend time connecting with providers directly, both virtually and in person, and assimilating and analyzing data to gain better visibility into provider experience.
This is a fast-paced working environment that requires the ability to multitask with attention to detail and excellent organizational skills.
This is an Idaho-based position, and you will have the flexibility to work remotely* as you take on this challenging and rewarding work.
If you are located in Idaho, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:- Manage provider complaints to resolution when initiated through regulators. Report status updates to IDHW and providers, as needed. Implement solutions that educate network on how to resolve issues with UHC resources
- Proactively partner with providers to identify opportunities for improvement, opportunities for growth and collaboration, and to gain general feedback regarding provider experience
- Partner with the COO to investigate and solve operational challenges. Report status updates to IDHW and providers, as needed. Maintain consultative and collaborative approach with providers through resolution
- Engage in onsite visits with providers. Utilize data analysis to determine the best strategy to choose which providers should be visited. Factors may include complaints, claim volume, attribution, quality measures, overlap with other teams, etc.
- Manage regulatory reports for the Idaho network. Partner with technical and functional teams to compile and audit reports
- Manage HCBS Provider Advocates (2), Workforce Development Administrator, Credentialing Coordinator, and Provider Claims Educator, which includes coaching, mentorship, collaboration, auditing and monitoring, establishing development and career planning, and more
- At least monthly, facilitate meetings with all provider-facing teams including, but not limited to provider relations, network contracting, growth, quality, and subcontractor provider teams
- Attend key provider conferences
- Show leadership with subcontractors who manage provider networks, including dental and vision
- Lead and facilitate meetings with providers and provider groups including IHA and other provider meetings where regulators are present. Attend and contribute to other virtual provider meetings
- Attend assigned advisory committees and contribute to the conversation showing leadership and subject matter expertise about our provider experience
- Partner with other provider teams to build expertise and relationships including credentialing, contracting, provider education, etc.
- Partner with providers in the adoption of enterprise tools that reduce administration, including but not limited to POCA (Point of Care Authorizations)
- Monitor Provider NPS with a focus on improvement
- Oversee provider communications, including the following:
- Manage annual update and publication of provider manual
- Participate in quarterly provider newsletter production
- Conduct provider website review monthly and partner with web teams for updates as needed
- Attend Call Calibration sessions to better understand provider experience and provide coaching and guidance to customer service team to improve the experience
- Be a subject matter expert regarding contract obligations relating to network
- Meet with IDHW and other regulatory points of contact, as needed. Focus on relationship building, maintaining awareness and transparency, and making progress
- Consistently monitor network adequacy through Geo-Access reports and partner with UHN and other network teams to fill network gaps
- Partner with Member Engagement Coordinator to solicit member feedback around provider experience and network gaps
- Partner with the SDoH Navigator and Population health team to drive Health Equity initiatives and SDoH goals within the network of providers
- Partner with UHC and other functional areas on Value Based Contracting opportunities and execution
- Represent UHC in in-person provider meetings, IDHW Provider Forums, and other Provider Related conferences, which will require the ability to travel within ID at least 25% of the time
You9ll 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 of Provider Network Relationship Experience
- 4+ years of Medicaid and/or Medicare Experience
- 4+ years of experience managing multiple projects
- 4+ years of experience with direct communication with Regulators
- Understanding of Medicaid contracting process, including downstream agreements
- Intermediate level of proficiency with MS Word, Excel, and PowerPoint
- Proven ability to establish and monitor key performance indicators
- Proven ability to meet deadlines
- Proven ability to influence course of action when other teams are directly accountable for outcomes
Preferred Qualifications:- Experience with Compliance Audits
- Proven excellent organizational skills
- Proven reporting techniques (SQL, PowerBI, etc.)
*All employees working remotely will be required to adhere to UnitedHealth Group9s 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, you9ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 - $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
