Provider Network Access Specialist - Remote in New Mexico
UnitedHealth Group
- Albuquerque, NM
- Permanent
- Full-time
- Confirm contract compliance specifics to meet the needs Turquoise Care contract network standards
- Work with cross-functional teams within UnitedHealthcare to strengthen provider networks across multiple functions including but not limited to behavioral health, physical health, dental and vision
- Conduct advocacy activities with targeted providers to solicit participation
- Work with internal groups to identify, understand, and / or improve internal tools, resources, systems, and capabilities that can maximize provider and member experience
- Analyze data to determine root cause of issue (e.g., identify trends and patterns; identify outliers and anomalies) and / or escalate problem to appropriate group for further analysis as necessary
- Own network adequacy reporting on behalf of health plan per state regulator requirements
- Act as health plan Subject Matter Expert (SME) on latest contracting status for essential providers
- Perform network analysis to identify potential strategic opportunities to increase and maintain the network
- Works with minimal guidance; seeks guidance on only the most complex tasks
- Provides explanations and information to others on difficult issues
- Acts as a resource for others with less experience
- Must be collaborative and able to work across a matrix organization
- Understands company-wide interfacing functions including UHC Operations, UHN contracting and negotiation, Service Coordination, Customer Service
- Apply knowledge of applicable health care industry practices, trends and issues to communicate about how our products / services can benefit members and providers
- 2+ years of healthcare experience
- 1+ years of working in provider network communications and interactions
- Demonstrated ability to communicate clearly and professionally with clients
- Intermediate+ proficiency in Excel
- Proficiency in MS Office (Word, SharePoint, Outlook, PowerPoint)
- Must live in New Mexico and be able to travel 10% of the time
- Experience with Network Adequacy Reporting
- Have working knowledge of Medicaid or previous MCO experience