Healthcare Provider Network Market Consultant – Plano, TX - Full-time / Part-time

Healthcare Provider Network Market Consultant – Plano, TX

Primary Responsibilities:

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)

The Network Program Consultant is responsible for the successful program design, compliance with network requirements, network assessment and selection, and program/product implementation. This includes enterprise-wide Clinically Integrated Network teams that focus on specific clinical area Lines of Service (e.g., Cardiology, Women's Health, Oncology, etc.) to improve the quality and affordability through improvements in appropriateness and effectiveness. Network Program Consultants may perform network analysis and strategy development and implementation; obtain data, verify validity of data, and analyze data as required, and analyze network availability and access. Other responsibilities may also include making recommendations regarding use, expansion, selection of networks for various products based on that analysis.

• Anticipate customer needs and proactively develop solutions to meet them


• Serve as a key resource on complex and/or critical issues


• Solve complex problems and develop innovative solutions


• Perform complex conceptual analyses


• Review work performed by others and provide recommendations for improvement


• Forecast and plan resource requirements


• Authorize deviations from standards


• May lead functional or segment teams or projects


• Provide explanations and information to others on the most complex issues


• Motivate and inspire other team members.


• Function independently, meeting with physicians to discuss OptumInsight tools and programs focused on improving the quality of care for Medicare Advantage Members


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  Utilize data analysis, identify and target providers who would benefit from our Medicare Risk Adjustment training and documentation/coding resources


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  Educate providers on how to improve their Risk Adjustment Factor (RAF) scores, which measure their patients' health status


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  Reach out to physicians, medical groups, IPAs and hospitals, to build positive, long-term, consultative relationships


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  Develop comprehensive, provider-specific plans to increase their RAF performance


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  Train providers on our Risk Adjustment programs and tools, and work toward the adoption of these programs in to their practices


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  Collaborate with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment education efforts

Required Qualifications:  

• Bachelor's degree or significant relevant work experience; advanced degree a plus


• 2+ years of experience working in healthcare with Managed Care and Medicare programs


• 1+ years making presentations and demonstrating training to live audience


• Intermediate (or better) level of proficiency in MS Office Suite; prefer strong MS Excel skills


• Experience with provider network management, physician contracting, healthcare consulting, Medicare Advantage sales or Pharmaceutical sales

Preferred Qualifications:

• Provider network management, contracting, sales or consulting experience


• Excellent written and oral communication skills with internal and external business partners and employees


• Strong business acumen and analytical skills


• Exceptional presentation skills; experience giving group presentations is preferred


• Ability to develop long term relationships


• Strong influencing and negotiation skills


• Results-orientation; must be self-motivated and goal oriented and able to work under ambiguity; good work ethic & desire to succeed


• Strong process and project management skills


• Ability to work independently and remain on task; ability to prioritize and meet deadlines


• Good organization and planning skills


• Ability to travel as necessary; daily travel within the designated market area and possible monthly travel outside their designated market 

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world?s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Job Keywords: Healthcare, Managed Care, Hospital Contracting, Physician Contracting, Ancillary Contracting, Provider Network, Network Development, Provider Services. Provider Education, Provider Relations, Pharmaceutical Sales