Member/ Provider Relations Advocate - Remote in WV - Full-time / Part-time

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The Provider Relations Advocate is responsible for member advocacy for members residing in long term care facilities along with the full range of provider relations and service interactions within Optum, including working on end-to-end provider issue resolution, ease of use of physician portal and future service enhancements, and training & development of external provider education programs. Provider Relations Advocates design and implement programs to build and nurture positive relationships between the health plan, providers (physician, facilities, etc.), and practice managers. Responsibilities may also include the project management of complex issue resolution involving cross functional teams.  

This position will cover an assigned territory in West Virginia. The individuals selected must live in WV.

If you are located in the state of West Virginia, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Engagement with internal resources to project manage provider issue resolution (claims, credentialing, provider set-up)


• Provider education and outreach regarding policies, processes, and ease of use of our provider self-service portal, provider express


• Responsible for the delivery of external provider training and education programs either in-person, virtually or through larger external provider events


• Build and nurture trusted relationships with high touch and territorial providers in assigned counties for all LOB.


• Establish recurring monthly meetings with assigned high-touch providers to discuss outstanding issues and the appropriate escalation path for resolution


• Onsite Member Visits: Act as the facility guardian angel when doing individual member visit rounds (if/when advocate finds anything unsafe or damaged e.g. closet doors off track, spills, residents in distress, etc., the MA alerts the nurses station immediately)


• Carry out open communication/discussions with members and/or responsible parties about member coverage/benefits, rights and responsibilities, complaints, concerns, etc.

• Coordinate solutions for any/all requested support for member services by the APC


• Educate SNF schedulers/transporters on coordinating benefit verification and/or authorizations with community based PAR/NONPAR providers along with onsite support for full-day SNF “batch visits” by optometry, podiatry and audiology specialists.  


• Provide disenrollment assistance with the APC, SNF, member, POA, etc.


• Maintain tracking on Hospice transitions outside of the SNF


• Participate and/or sponsor facility/resident events to include but not limited to Quarterly Member Retention and Staff Appreciation Events 


• Deliver via email bi-monthly LIS Evidence Rider Notices, Rosters, and ID-Cards to the SNF


• Create bi-monthly membership accounting reports for the health plan partners


• Make monthly Healthplan Quality Assurance calls to SNF departments and to member POAs


• Communicate weekly to the SNFs of upcoming new membership and/or disenrollments transitions (utilizing and monitoring the TRR)


• Assists with LIS applications and/or BAE for members


• Conduct Annual Member Satisfaction Surveys


• Support any/all Network Management Contracting & Credentialing needs

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High school diploma/GED or above


• 2+ years of provider relations and/or provider network experience


• 2+ years of experience with Medicare and Medicaid regulations


• 2+ years presentation experience


• Intermediate level of proficiency in billing / coding / claims analysis; claim issue resolution


• Intermediate level of proficiency with MS Excel


• Valid driver’s license


• If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

• Undergraduate degree


• Experience with providers in this region


• Provider Relations experience at the facility level


• Excellent communication skills


• Solid organization and planning skills


• Ability to work independently


• Demonstrated ability to build strong relationships with providers and with internal departments

UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.

You can learn more about all we are doing to fight COVID-19 and support impacted communities: .

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

 Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.

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