Network Coordinator - Jacksonville, FL

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WellMed is now part of the OptumHealth division under the greater UnitedHealth Group umbrella.

WellMed is a healthcare delivery system serving more than 90,000 patients, primarily Medicare eligible seniors, in Texas and Florida through primary care clinics, multi-specialty clinics, and contracted medical management services. Headquartered in San Antonio, Texas, WellMed is an industry leader in medical risk management, highly effective disease management and chronic care programs, healthcare delivery services and more.

Our focus and mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. We are innovators in preventative healthcare, striving to change the face of healthcare delivery for seniors. Our providers and support staff are selected for their dedication to the senior population and focus on preventative, proactive patient care.

The Network Coordinator is responsible for developing, maintaining and servicing a high quality, marketable and satisfied provider network within an assigned geographic area. Key responsibilities include recruitment, contracting, education and service for physicians and ancillary providers. The Network Coordinator helps assigned primary care physicians operate successfully within the PHC healthcare delivery model. This position works closely with local sales and medical staff as well as corporate network support staff. This position is expected to maintain strong working relationships with assigned physicians, hospitals and ancillary providers.

Primary Responsibilities:

• Under the direction of the Market Manager, works closely with Tier 1 and other PCPs to ensure they have the tools they need to meet Quality Metric goals including DataRaps


• Completes detailed analysis of Quality Metric reports and tracks data at the patient level to ensure new members are seen within 90 days, all members seen annually and completion of the actions needed to meet the remaining quality metrics; provides physician and office education to improve metrics as needed


• Participates in creation and execution of a local network development plan to assure network adequacy


• Recruits and contracts physicians and ancillary providers within established guidelines gather credentialing information and assure provider directory accuracy


• Conducts new provider orientations and deliver in-service training to educate providers and their staffs on PHC products, processes and compensation arrangements


• Maintains open communication with providers on health plan issues related to claims, eligibility, RAPS, disease management, utilization management, reimbursement and quality programs.


• Facilitates PCP appointments for new members so PCPs can assess health status, get the member into an appropriate treatment program and refer high risk members to disease management programs


• Collaborates with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs


• Resolves provider and member specific issues related to claims, eligibility and referrals


• Handles scheduling, agenda, materials, location, meals and minutes of provider meetings as needed


• Works closely with contracting team to ensure provider data is correct and Provider directories include any needed updates; completes PIC forms as needed


• Provides information and participate in management meetings as requested


• Performs all other related duties as assigned

Required Qualifications:

• Bachelor's degree in related field, or 4+ additional years of comparable work experience beyond the required years of experience


• 3+ years of provider relations or managed care experience


• 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


• Excellent analytical and problem solving skills with effective follow through


• Strong verbal and written communication skills


• Solid knowledge of local provider community

Preferred Qualifications:

• Significant understanding of medical care financing and delivery systems, provider contracting, reimbursement arrangements and network management


• Professional provider relations experience involving physicians and administrative staff


• Provider recruitment and contracting experience

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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, 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.