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Hours Full-time, Part-time
Location Santa Ana, CA
Santa Ana, California

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 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. 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:



  • Develop, translate and execute strategies or functional/operational objectives for a region, line of business, or major portion of a business segment functional area

  • Direct others to resolve highly complex or unusual business problems that affect major functions or disciplines

  • Drive programs that impact markets of customers and consumers

  • Significant Travel required

  • Primary architect of west region networks with 'ACO' team reporting directly to the position

  • Responsibility and travel for all West region states which include 3-5 year vision of network configurations, co-strategic implementation with Optum, addressing counter strategy positions via network consolidation and vertical integration, approach to multi-system systems in the West Region, advancement of pay for performance models, expertise and unification of UHC Medicare, Commercial, Medicaid and Military business requirements

Requirements

Required Qualifications:



  • Undergraduate degree

  • 10+ years of experience working with a managed care organization, health insurer, or consultant in a network management/contract management role, such as contracting, provider services, etc.

  • 8+ years of experience in data analysis

  • 5+ years of experience managing staff

  • 3+ years of project management or project lead experience

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

  • 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

  • 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)

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.


 


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