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Provider Network Program Manager - Salt Lake City, UT

Optum Care Delivery
Salt Lake City, Utah, United States (on-site)
7 days ago


Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

Optum is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry.

The Provider Network Program Manager with OptumCare is responsible for developing, maintaining, and servicing a high quality, marketable and satisfied provider network within an assigned geographic area. Key responsibilities include recruitment and contracting, education, and servicing of assigned providers. The Provider Network Program Manager helps assigned providers operate successfully within our healthcare delivery model by providing strategic planning and tools to meet goals. This position is expected to build and sustain strong working relationships with cross-functional departments, vendors, local sales, and assigned providers. The Provider Network Program Manager is accountable for overall performance and profitability for their assigned groups, as well as ownership and oversight to provide redirection as appropriate.

This position will require travel throughout the greater Salt Lake City area.

Primary Responsibilities:
  • Educate providers to ensure that they have the tools they need to meet quality, risk adjustment, growth (as appropriate), and total medical cost goals per business development plans facilitated through strategic meetings
  • Ensure providers have in-depth understanding of OptumCare model to include, but not limited to, patient care best practices, contractual obligations and program incentives
  • Conduct detailed analysis of various reports by tracking data to develop a strategic plan to ensure performance goals are achieved
  • Ensure the overall strategic plan incorporates interventions with internal departments including Medical Directors, Clinical Educators/Coders, Quality/HEDIS nurses, pharmacists and others as needed
  • Collaborate with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs and/or Specialists
  • Conduct new provider orientations and ongoing education to providers and their staffs on OptumCare programs, processes and compensation arrangements
  • Maintain open communication with providers to include issue resolution on health plan issues related to credentialing, claims, eligibility, disease management, utilization management, quality, and risk adjustment programs
  • Collaborate with provider groups to develop, execute, and monitor performance and patient outcomes improvement plans
  • Handle or ensure appropriate scheduling, agenda, materials, location, meals, and minutes of provider meetings as needed
  • Collaborate with contracting team to ensure provider data is correct and provider directories include any needed updates
  • Represent OptumCare by coordinating company sponsored provider events (summits, learning sessions)
  • Regularly meet with cross-functional team to create, revise, and adjust strategy for assigned provider groups to meet overall performance goals
  • Introduce and advocate company resources to facilitate practice optimization

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:
  • Bachelor’s Degree or equivalent work experience
  • 3+ years of experience working with a managed care organization or health insurer OR IN A PRIMARY CARE SETTING; or as a consultant in a network/contract management role, such as contracting, provider services, etc.
  • 2+ years of experience in data analysis
  • Demonstrated experience with making presentations to both small and large groups
  • Intermediate proficiency with MS Suite (including Word, PowerPoint, and Excel)
  • Ability to work evenings and weekends on occasion based on business needs

Preferred Qualifications:
  • 2+ years of project management or project lead experience
  • 2+ years of experience working with claims systems
  • 2+ years of experience with facility/ancillary contracts
  • Established knowledge of local provider community
  • Expertise in physician/facility/ancillary contract reimbursement methodologies
  • Understanding of medical financial statements and delivery systems, provider contracting, reimbursement arrangements, and network management
  • Ability to manage multiple priorities and maintain an organized approach
  • Create business strategies through excellent analytical and problem solving skills with effective follow through
  • Exceptional interpersonal skills with ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives, and other health plan staff

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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 Information

  • Job ID: 67877144
  • Workplace Type: On-Site
  • Location:
    Salt Lake City, Utah, United States
  • Company Name For Job: Optum Care Delivery
  • Position Title: Provider Network Program Manager - Salt Lake City, UT
  • Job Function: Any
  • Job Type: Full-Time

Please refer to the company's website or job descriptions to learn more about them.

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