596398 - Sr. Provider Relations Advocate - Northern Delaware (Newark DE)

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UnitedHealth Networks, part of the UnitedHealth Group family of companies, is now looking for a Senior Provider Relations Advocate for our team in Newark DE. This person will be responsible for providing support and advocacy for Long Term Services & Supports (LTSS) and Long Term Care (LTC) providers in the northern part of Delaware (New Castle County).  Approximately half your time will be spent supporting providers from our office location, and the other half of the time will be spent in the field with regular onsite visits to providers.  Providers include the following areas: Personal Care Services, Homemaker Services, Respite Care, Cognitive Services, Personal Emergency Response, Home Delivered Meals, Adult Day Services, Consumer Directed Attendant Care, Home Modifications, Day Habilitation, and Assisted Living.

The Senior Provider Relations Advocate is responsible for the full range of provider relations and service interactions within UnitedHealth Group, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training & development of external provider education programs. Senior Provider Relations Advocates design and implement programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Responsibilities also include directing and implementing strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims.

Primary Responsibilities:

• Assess and interpret customer needs and requirements


• Identify solutions to non-standard requests and problems


• Solve moderately complex problems and/or conduct moderately complex analyses


• Work with minimal guidance; seek guidance on only the most complex tasks


• Translate concepts into practice


• Provide explanations and information to others on difficult issues


• Coach, provide feedback, and guide others


• Act as a resource for others with less experience


• Other duties as assigned

Required Qualifications:

• Undergraduate degree or 5+ years of related experience


• 3+ years of experience in a provider relations, provider network, and/or provider contracting role


• Experience with claims processing and issue resolution


• Demonstrated ability to organize and manage multiple ongoing projects within expected timeframes


• Must show attention to detail and be capable of taking responsibility for completion of assigned projects within deadlines; ability to prioritize and meet deadlines from multi-staff members within the department


• Professional verbal and written communication skills, including the ability to develop correspondence to facilities and clinicians


• Experience providing presentations


• Ability to work independently and remain on task


• At least an intermediate level of proficiency with MS Word, MS Excel & MS PowerPoint

Preferred Qualifications:

• Prior experience servicing Long Term Services & Supports (LTSS) and/or Long Term Care (LTC) providers


• Knowledgeable about the credentialing process and claims payment process


• Experience with Medicare and Medicaid regulations

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: Long Term Services & Supports, LTSS, Long Term Care, LTC, Personal Care Services, Homemaker Services, Respite Care, Cognitive Services, Personal Emergency Response, Home Delivered Meals, Adult Day Services, Consumer Directed Attendant Care, Home Modification, Newark, Wilmington, Delaware, DE