UnitedHealthcare
Provider Network Access Specialist - Remote
UnitedHealthcare, Albuquerque, New Mexico, United States, 87101
Provider Network Access Specialist - Remote
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Ready to make a difference? Join us to start
Caring. Connecting. Growing together.
If you are located in the United States, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities
Confirm contract compliance requirements to meet the needs of the Turquoise Care contract network standards
Possess knowledge of Managed Care Organization (MCO) contracting/credentialing process
Own network adequacy reporting on behalf of the health plan per state regulator requirements
Experience working with providers/facilities in order to conduct advocacy initiatives with targeted providers to solicit participation
Work with cross‑functional teams within UnitedHealthcare to strengthen provider networks across multiple functions including HCBS, behavioral health, physical health, dental and vision
Work with internal groups to identify, understand, and improve internal tools, resources, systems, and capabilities that can maximize provider and member experience
Analyze data to determine root causes of issues (e.g., identify trends, patterns, outliers, and anomalies) and/or elevate problems to the appropriate group for further analysis
Act as a health plan subject‑matter expert on latest contracting status for essential providers
Perform network analysis to identify potential strategic opportunities to increase and maintain the network
Work with minimal guidance; seeks guidance on only the most complex tasks
Provide explanations and information to others on difficult issues
Act as a resource for others with less experience
Collaborate across a matrix organization
Understand company‑wide interfacing functions including Claims, UHC Operations, UHN contracting and negotiation, Service Coordination, Customer Service
Apply knowledge of applicable health‑care industry practices, trends, and issues to communicate how our products or services can benefit members and providers
Required Qualifications
1+ year of experience in provider network communications and provider interactions
Working knowledge of Medicaid or MCO experience
Experience with Network Adequacy Reporting
Knowledge of MCO contracting/credentialing process
Intermediate or higher proficiency in Excel for data analysis and root‑cause determination
Intermediate proficiency in MS Office (Word, SharePoint, Outlook, PowerPoint)
Proven ability to communicate clearly and professionally with clients
Ability to travel up to 10% of the time in New Mexico
Preferred Qualifications
2+ years of healthcare experience
Reside in New Mexico
Working knowledge of SQL
2+ years working with health‑care claims
All employees working remotely must 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 401(k) contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $58,800 to $105,000 annually based on full‑time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone—regardless of race, gender, sexuality, age, location, or income—deserves the opportunity to live their healthiest life. We are committed to mitigating environmental impact and delivering equitable care that addresses health disparities and improves health outcomes.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.
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Caring. Connecting. Growing together.
If you are located in the United States, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities
Confirm contract compliance requirements to meet the needs of the Turquoise Care contract network standards
Possess knowledge of Managed Care Organization (MCO) contracting/credentialing process
Own network adequacy reporting on behalf of the health plan per state regulator requirements
Experience working with providers/facilities in order to conduct advocacy initiatives with targeted providers to solicit participation
Work with cross‑functional teams within UnitedHealthcare to strengthen provider networks across multiple functions including HCBS, behavioral health, physical health, dental and vision
Work with internal groups to identify, understand, and improve internal tools, resources, systems, and capabilities that can maximize provider and member experience
Analyze data to determine root causes of issues (e.g., identify trends, patterns, outliers, and anomalies) and/or elevate problems to the appropriate group for further analysis
Act as a health plan subject‑matter expert on latest contracting status for essential providers
Perform network analysis to identify potential strategic opportunities to increase and maintain the network
Work with minimal guidance; seeks guidance on only the most complex tasks
Provide explanations and information to others on difficult issues
Act as a resource for others with less experience
Collaborate across a matrix organization
Understand company‑wide interfacing functions including Claims, UHC Operations, UHN contracting and negotiation, Service Coordination, Customer Service
Apply knowledge of applicable health‑care industry practices, trends, and issues to communicate how our products or services can benefit members and providers
Required Qualifications
1+ year of experience in provider network communications and provider interactions
Working knowledge of Medicaid or MCO experience
Experience with Network Adequacy Reporting
Knowledge of MCO contracting/credentialing process
Intermediate or higher proficiency in Excel for data analysis and root‑cause determination
Intermediate proficiency in MS Office (Word, SharePoint, Outlook, PowerPoint)
Proven ability to communicate clearly and professionally with clients
Ability to travel up to 10% of the time in New Mexico
Preferred Qualifications
2+ years of healthcare experience
Reside in New Mexico
Working knowledge of SQL
2+ years working with health‑care claims
All employees working remotely must 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 401(k) contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $58,800 to $105,000 annually based on full‑time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone—regardless of race, gender, sexuality, age, location, or income—deserves the opportunity to live their healthiest life. We are committed to mitigating environmental impact and delivering equitable care that addresses health disparities and improves health outcomes.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.
#J-18808-Ljbffr