Network Program Consultant - Telecommute

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. Primary Responsibilities:


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

Unet claim data knowledge is required, Oxford claim data knowledge would be a plus. Needs to be able to review data and understand the outcome of a claim for analysis.
 

Required Qualifications:


Undergraduate degree or equivalent work experience

5 or more years experience in claims processing, provider data maintenance, contracting, or contract loading

Knowledge of contracting methodologies

Unet claim data knowledge

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

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

Needs to be able to review data and understand the outcome of a claim for analysis.
Preferred Qualifications:


Project Management experience

Oxford claim data knowledge

Leadership skills
 
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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.
 


 

Keywords:Claims Processing, Unet data, Oxford data, provider data, contracting methodologies, contract loading, Telecommute, work from home, Minnetonka, MN, Minnesota