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in Westerville, OH

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Hours Full-time, Part-time
Location Westerville, OH
Westerville, Ohio

About this job

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 Associate Director of Network Programs 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. Associate Directors of Network Programs 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.


 


Primary Responsibilities:



  • Own an end to end process

  • Develop functional, market level, and/or site strategy, plans, production and/or organizational priorities

  • Identify and resolve technical, operational and organizational problems outside own team

  • Product, service or process decisions are most likely to impact entire functions and/or customer accounts (internal or external)

  • Ability to manage multiple priorities at the same time

  • Ability to communicate effectively to providers and associations

Requirements

Required Qualifications:



  • Undergraduate degree

  • 5+ years of managed care experience

  • 5+ years of experience managing staff

  • 3+ years of project management or project lead experience

  • Intermediate level of proficiency with all facility/ancillary contract reimbursement methodologies

  • Ability to convey complex or technical information in a manner that others can understand

  • Excellent communication skills, including ability to communicate effectively with various levels of leadership

  • Advanced proficiency in MS Office (Excel, Access and PowerPoint)

Preferred Qualifications:



  • 5+ years of experience in data analysis

  • 5+ years of experience with claims systems

  • Strong knowledge of business processes that impact facility/ancillary contact loading and auditing

  • 3+ years of experience with contract submission, validation and maintenance

  • Proficient in speaking with providers

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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.


 


Job Keywords: Managed Care, Healthcare, Network Program Specialist, network requirements, network assessment, network selection, network data management, provider data analysis, medical claims, claims processing, claims resolution, medical coding, project management, Supervisor, Manager, Director, Westerville, Ohio, OH