Director Provider Engagement Humana Jobs (NOW HIRING)

Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere. As a team member of our Senior Community Care (SCC) team, we work to provide care to patients at home, nursing homes and assisted living for senior housing. This life-changing work adds a layer of support to improve access to care. We're connecting care to create a seamless health journey for patients across settings. Join us to start Caring. Connecting. Growing together.

The Provider Engagement Representative (PER) will manage business relationships for contracted Skilled Nursing Facilities (SNF) for all UHC lines of business in Indiana, including working on end-to-end provider issues and call quality, and training & development of external provider education programs. The PER will conduct in-person meetings with Institutional Special Needs Plan (ISNP) facilities is critical to supporting the Senior Community Care (SCC) business to meet growth plans within the market.

The PER collaborates enterprise wide with other business units (Care Transitions, Optum Health) and provides support for Institutional and Institutional-Equivalent Special Needs Plan growth, affordability, and quality. This role facilitates and coordinates Business Review Meetings, Joint Operating Committee, and Provider Engagement Meetings for SCC.

*This position will be remote with travel within the NY market.

Primary Responsibilities:

• Develop and maintain overall UnitedHealthcare business relationships with Skilled Nursing Facilities & Assisted Living Facilities 
• Designs and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.) and business office managers.
• Direct and implement strategies relating to the development and management of a provider network.
• Support all education opportunities on UnitedHealthcare businesses which include in person and telephonic interactions
• Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs.
• Lead and/or support external facing Account and business review meetings with key Skilled Nursing Facility staff to review financial performance, contract methodology, and reimbursement opportunities
• Provide explanations and information to others on topics within area of expertise
• Identify ancillary provider gaps, and support contracting of new providers in areas where needed
• Prioritize and organize own work to meet deadlines cross functionally within the organization
• Investigate non-standard requests and issues, prior to escalation if needed
• Compass Data Base - update & maintain regularly with information following AR, Bus Review and JOC Meetings with facilities
• Support Post-Acute Priorities
• ISNP and IE-SNP Business Development - assist with planned growth initiatives for ISNP/IE-SNP business
• Education and Training to facilities on Medication Adherence requirements for members
• Provide outreach and education on updated policies, new initiatives, performance, and others as necessary

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:

• 2 years of provider relations or provider network management experience
• 1 year of experience with Medicare/Medicaid regulations
• Intermediate level of proficiency with MS Word, Excel, PowerPoint and, Outlook
• Driver's License and access to a reliable transportation
• Ability to travel 25% of the time within the NY area

Preferred Qualifications:

• Experience working in a Skilled Nursing or Assisted Living Facility
• Ability to prioritize and meet deadlines
• Familiarity with claims processing and issue resolution

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.