Optum
Provider Engagement Representative - Remote
Optum, Jacksonville, Florida, United States, 32290
Provider Engagement Representative - Remote
Join to apply for the
Provider Engagement Representative - Remote
role at
Optum .
Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry‑leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs—helping patients access and navigate care anytime and anywhere.
As a team member of our Senior Community Care (SCC) product, we work to provide care to patients at home in a nursing home, assisted living, and senior housing. This life‑changing work adds a layer of support to improve access to care and connects care to create a seamless health journey for patients across care settings. The Provider Engagement Representative (PER) manages business relationships for contracted Skilled Nursing Facilities (SNF) for all UHC lines of business in Florida, working on end‑to‑end provider issues, call quality, and training & development of external provider education programs. The PER conducts in‑person meetings with Institutional Special Needs Plan (ISNP) facilities and collaborates enterprise‑wide with other business units to support Institutional Special Needs Plan growth, affordability, and quality. This role facilitates and coordinates Business Review Meetings, Joint Operating Committee, and Provider Engagement Meetings for SCC.
Primary Responsibilities
Develop and maintain overall UnitedHealthcare business relationships with Skilled Nursing Facilities
Design and implement programs to build and nurture positive relationships between the health plan, providers, and business office managers
Direct and implement strategies relating to the development and management of a provider network
Support all education opportunities on UnitedHealthcare businesses—including in‑person and telephonic interactions
Identify gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs
Lead and/or support external‑facing accounts and business review meetings with key Skilled Nursing Facility staff to review financial performance, contract methodology, and reimbursement opportunities
Provide explanations and information to others on topics within area of expertise
Identify ancillary provider gaps and support contracting of new providers where needed
Prioritize and organize own work to meet deadlines crossing functions within the organization
Investigate non‑standard requests and issues, prior to escalation if needed
Maintain Compass Data Base with information following AR, Business Review, and Joint Operating Committee meetings with facilities
Support Post‑Acute Priorities
ISNP Business Development—assist with planned growth initiatives for ISNP business
Education and training to facilities on Medication Adherence requirements for members
Provide outreach and education on updated policies, new initiatives, performance, and others as necessary
Required Qualifications
2+ years of provider relations or provider network management experience
1+ year of experience with Medicare/Medicaid regulations
Intermediate proficiency with MS Word, Excel, PowerPoint and Outlook
Ability to travel 25% of the time within Northeast, FL area
Preferred Qualifications
Experience working in a Skilled Nursing or Assisted Living Facility
Familiarity with claims processing and issue resolution
Ability to prioritize and meet deadlines
Remote employees must adhere to UnitedHealth Group's Telecommuter Policy
The salary for this role will range from $58,800 to $105,000 annually based on full‑time employment. Benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution.
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, and income—deserves the opportunity to live their healthiest life. We are committed to mitigating our impact on the environment 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.
Referrals increase your chances of interviewing at Optum by 2x.
#J-18808-Ljbffr
Provider Engagement Representative - Remote
role at
Optum .
Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry‑leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs—helping patients access and navigate care anytime and anywhere.
As a team member of our Senior Community Care (SCC) product, we work to provide care to patients at home in a nursing home, assisted living, and senior housing. This life‑changing work adds a layer of support to improve access to care and connects care to create a seamless health journey for patients across care settings. The Provider Engagement Representative (PER) manages business relationships for contracted Skilled Nursing Facilities (SNF) for all UHC lines of business in Florida, working on end‑to‑end provider issues, call quality, and training & development of external provider education programs. The PER conducts in‑person meetings with Institutional Special Needs Plan (ISNP) facilities and collaborates enterprise‑wide with other business units to support Institutional Special Needs Plan growth, affordability, and quality. This role facilitates and coordinates Business Review Meetings, Joint Operating Committee, and Provider Engagement Meetings for SCC.
Primary Responsibilities
Develop and maintain overall UnitedHealthcare business relationships with Skilled Nursing Facilities
Design and implement programs to build and nurture positive relationships between the health plan, providers, and business office managers
Direct and implement strategies relating to the development and management of a provider network
Support all education opportunities on UnitedHealthcare businesses—including in‑person and telephonic interactions
Identify gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs
Lead and/or support external‑facing accounts and business review meetings with key Skilled Nursing Facility staff to review financial performance, contract methodology, and reimbursement opportunities
Provide explanations and information to others on topics within area of expertise
Identify ancillary provider gaps and support contracting of new providers where needed
Prioritize and organize own work to meet deadlines crossing functions within the organization
Investigate non‑standard requests and issues, prior to escalation if needed
Maintain Compass Data Base with information following AR, Business Review, and Joint Operating Committee meetings with facilities
Support Post‑Acute Priorities
ISNP Business Development—assist with planned growth initiatives for ISNP business
Education and training to facilities on Medication Adherence requirements for members
Provide outreach and education on updated policies, new initiatives, performance, and others as necessary
Required Qualifications
2+ years of provider relations or provider network management experience
1+ year of experience with Medicare/Medicaid regulations
Intermediate proficiency with MS Word, Excel, PowerPoint and Outlook
Ability to travel 25% of the time within Northeast, FL area
Preferred Qualifications
Experience working in a Skilled Nursing or Assisted Living Facility
Familiarity with claims processing and issue resolution
Ability to prioritize and meet deadlines
Remote employees must adhere to UnitedHealth Group's Telecommuter Policy
The salary for this role will range from $58,800 to $105,000 annually based on full‑time employment. Benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution.
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, and income—deserves the opportunity to live their healthiest life. We are committed to mitigating our impact on the environment 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.
Referrals increase your chances of interviewing at Optum by 2x.
#J-18808-Ljbffr