UnitedHealth Group

Network Program Consultant - Remote

UnitedHealth Group$72K — $130K *
US-AnywhereRemote in Nashville, TN
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • 2+ years of healthcare experience with medical terminology
  • Intermediate proficiency in MS Office (Excel, PowerPoint, Word)
  • Willingness to travel up to 75% within Central South Tennessee
  • Active driver's license and auto insurance
  • Access to reliable personal transportation

Responsibilities

  • Travel across assigned territory to meet with providers and discuss Optum tools and programs
  • Identify and target providers for coding and quality training
  • Establish long-term relationships with physicians and healthcare groups
  • Develop provider-specific plans to enhance RAF performance
  • Manage Risk and Quality Client Programs from start to finish
  • Consult with providers on documentation and coding gaps
  • Deliver training and resources tailored to specific provider needs

Benefits

  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase options
  • 401k contributions
  • Opportunities for career development and advancement
Full Job Description
If you are located in Nashville, TN, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

  • Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members. Will be out in the field 75% of time in defined territory with rare occasion of overnight travel
  • Utilizing data analysis, identify and target providers who would benefit from our coding, documentation and quality training and resources
  • Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and hospitals
  • Develop comprehensive, provider-specific plans to increase their RAF performance and improve their coding specificity
  • Manage end-to-end Risk and Quality Client Programs
  • Consult with provider groups on gaps in documentation and coding
  • Provide feedback on EMR/EHR systems where it is causing issues in meeting CMS standards of documentation and coding
  • Partner with a multi-disciplinary team to implement prospective programs as directed by Market Consultation leadership
  • Assists providers in understanding the Medicare quality program as well as CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
  • Assist providers in understanding quality and CMS-HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
  • Supports the providers by ensuring documentation supports the submission of relevant ICD -10 codes and CPT2 procedural information in accordance with national coding guidelines and appropriate reimbursement requirements
  • Provides ICD10 - HCC coding training to providers and appropriate office staff as needed
  • Develops and presents coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs
  • Delivers diagnosis coding tools to providers
  • Trains physicians and other staff regarding documentation, billing and coding and provides feedback to physicians regarding documentation practices
  • Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices
  • Collaborates with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts
  • Assist in collecting charts where necessary for analysis
  • Self-starter with the ability to work independently and remain on task; ability to prioritize and meet deadlines
  • Other duties, as assigned


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:

  • 2+ years of a healthcare background with medical terminology, familiarity of clinical issues
  • Intermediate level of proficiency in MS Office Excel, PowerPoint, Word with the ability to manipulate data, filter, create and present presentations
  • Must be able/willing to travel up to 75% of the time in the assigned territory across Central South Tennessee
  • Active, unrestricted driver\'s license and auto insurance
  • Access to reliable personal transportation to perform daily travel requirements


Preferred Qualifications:

  • Certified Professional Coder / CPC-A; equivalent certifications acceptable
  • CRC certification
  • 3+ years of provider network management, physician contracting, healthcare consulting, and Medicare Advantage experience
  • 2+ years of clinic or hospital experience and/or managed care experience
  • 1+ years of experience with Hospital or provider office EMR
  • 1+ years of coding performed at a health care facility
  • Territory management experience
  • Experience in Risk Adjustment, HEDIS/Stars, and gap closure initiatives
  • Experience in management position in physician practice
  • Project management experience
  • Knowledge of billing/claims submission and other related actions
  • Advanced proficiency in MS Office (Excel (Pivot tables, excel functions)
  • Proven nursing background i.e. LPN, RN, BSN
  • Proven effective ability to communicate with multiple stakeholders at various levels and the ability to collaborate with cross functional teams
  • Demonstrated ability to take responsibility and is internally driven to accomplish goals and recognize what needs to be done to achieve goals
  • Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer


*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 $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

About UnitedHealth Group

UnitedHealth Group is a medical facility. They offer health technology, health finance, and pharmacy services. They are utilizing clinical data and intelligence to assist in the redesign, automation, and deployment of technology to streamline administrative operations and clinical decision-making. Payment systems for both consumers and providers are critical components of a health-care system.

UnitedHealth Group Careers

Joining UnitedHealth Group means becoming part of a diverse team dedicated to making a difference. As a leader in health services and innovation, our company offers a variety of job opportunities that allow professionals to leverage their skills, drive innovation, and improve lives. Work You’ll Do At UnitedHealth Group, you’ll contribute to a mission-focused environment where your expertise will influence the health and well-being of people worldwide. Our employment opportunities span across a wide range of disciplines, from healthcare specialists to data analysts, ensuring that your career journey is both dynamic and rewarding. Transform Healthcare with Your Expertise UnitedHealth Group stands at the forefront of health innovation. Our team collaborates to deliver solutions that lead to better patient outcomes. Working with us, you’ll find yourself at the intersection of technology, healthcare, and leadership, providing key insights that drive industry transformation. Join Our Global Team As part of our team, you’ll engage with over 300,000 professionals globally, dedicated to building a diverse and inclusive workplace. UnitedHealth Group is not just a company; it’s a community where you can grow your career through continuous learning and leadership opportunities. Our commitment to diversity training ensures that every team member can thrive. UnitedHealth Group Career Development We are committed to your professional growth. Explore career paths filled with promising job opportunities and internships that will harness your potential and expand your capabilities. Whether you’re a seasoned professional or a recent graduate, you’ll find that our career development programs support your ambition at every level. Innovative Work Environment At UnitedHealth Group, innovation is at the core of our operations. We encourage our team to bring forward-thinking ideas that challenge the status quo and lead to breakthrough improvements in patient care. Be Part of a Great Team Our culture fosters a collaborative and supportive environment where every member’s contribution is valued. Enjoy the benefits of being part of a global team that’s committed to making a difference in people’s lives. Future-Proof Your Career With UnitedHealth Group, your career is future-proof. Dive into a range of positions that offer both challenges and rewards. Our robust support system includes unmatched training, development programs, and certification support to propel your career forward. Stay Connected Join Our Team Discover the right position that matches your skills and interests. We are always hiring and look for passionate, curious, and solution-driven team players. Search UnitedHealth Group jobs today and take the first step towards a fulfilling career. Keep Up to Date Stay informed with career tips, insider perspectives, and industry-leading insights you can use today—all from the people who work here. Read Careers Blog Job Alert Emails Customize your subscription to receive job alerts, the latest news, and insider tips tailored to your preferences. Explore the exciting and rewarding opportunities that await at UnitedHealth Group.
Learn more about UnitedHealth Group
Size
350,000 employees
Market Cap
$493.1 billion
Industry
Net Income
$15.4 billion
Founded
1974
5 Year Trend
+9.2%
Revenue
$257.1 billion
NASDAQ

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