Director Network Performance – Overland Park, KS

UnitedHealth Group
Published
May 13, 2022
Location
Atlanta, GA
Category
Job Type

Description

Combine two of the fastest growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Jobs related to managing provider networks that support client base. This includes hospital, physician, dental, and pharmaceutical networks. Examples include provider relations activities, analyzing provider performance, creating provider reimbursement arrangements, and credentialing activities.

Positions in this function are responsible for the successful program design, affiliate network improvement in key metrics (including HCC and HEDIS), compliance with network requirements, network assessment and selection, and program/product implementation.  Leads a team that aligns contracted providers with company initiatives, goals (revenue and expense) and quality outcomes.  Leads the network performance team to drive process and technology improvement initiatives that directly impact revenue, clinical performance, affordability, NPS, HEDIS/STAR measures and Quality Metrics, using standard project methodology (requirements, design, test, etc.).  Organizes the production of scheduled and adhoc client and operational reports relating to the development and performance of products and review with PCP practices.  Accountable for ensuring that each practice is meeting its financial and quality targets and develop action plans for those practices that are underperforming

Primary Responsibilities: 

  • Obtains data, verifies validity of data, and analyzes data as required
  • Analyzes network availability and access
  • May make recommendations regarding use, expansion, selection of networks for various products based on that analysis
  • Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff
  • Work most often impacts a large business unit, or multiple markets/sites
  • Develops and drives successful program design to execute on quality compensation models 
  • Perform frequent analysis of the Network that will inform future strategy and implementation of process
  • Develops and executes strategies for a function or discipline that span a large business unit or multiple markets/sites.
  • Leads a team and cross functional teams to achieve targeted performance in coding accuracy, HEDIS, CAHPS/HOS and affordability
  • Directs others to resolve business problems that affect multiple functions or disciplines.
  • Product, service or process decisions are most likely to impact multiple functions and/or customer accounts (internal or external)

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:

  • Undergraduate degree or equivalent experience
  • Full COVID19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance

Functional Competencies:

  • Review employer group/health plan expectations (e.g., commercial; government) in order to determine the potential impact to employer group/health plan membership
  • Gather data from relevant sources in order to respond to stakeholders' requests (e.g., employer groups; internal teams)
  • Analyze network and/or provider performance along key indicators (e.g., compliance with regulatory audits; financial performance; Benefit Cost Ratio; risk adjustment scores; prevalence rates; Unit Cost Reduction Trend) in order to determine which programs to implement and/or modify
  • Research competitor and external information regarding key network characteristics and contracting strategies in order to develop products and programs
  • Ensure relevant contract and demographic information is loaded into the applicable platform in order to support analysis and review
  • Review and/or analyze member/provider population information (e.g., cultural information; demographics; geographic coverage) in order to determine potential network gaps in care and risk adjustment indicator opportunities
  • Implement new rates with contracted providers based on provider performance
  • Validate network data for programs (e.g., transparency program)
  • Develop metrics and create performance reports for payforperformance programs (e.g., PBC; PCPI)
  • Determine performance metrics and programs to apply to specific providers based on competitive data, internal data (e.g., provider improvement opportunities) and applicable legal and regulatory requirements
  • Provide guidance to internal stakeholders regarding administration of contracts (e.g., contract language; coding)
  • Identify needs and create infrastructure and parameters for programs/networks/contracts (e.g., contract language; clinical quality initiatives; internal support)
  • Communicate with key stakeholders (e.g., network management contractors) to ensure programs/networks/contracts comply with standards
  • Provide input and feedback to senior leadership in order to suggest/recommend improvements to programs/networks/contracts
  • Coordinate with relevant internal and/or external stakeholders to ensure that programs/networks/contracts are designed and implemented to meet local, regional, and/or national market needs
  • Create and/or implement communication/training materials (e.g., talking points; FAQs; step action chart; metric evaluation tools) in order to educate affected stakeholders on new programs and/or processes
  • Conduct visits with external health care providers to promote risk adjustment score accuracy (e.g., early detection; accurate documentation and coding) and compliance with applicable regulatory guidelines (e.g., CMS; HEDIS/STARS Quality Measures)
  • Work with local, regional, and/or national networks and/or stakeholders in order build support for program/contract implementation
  • Seek feedback from relevant internal and/or external stakeholders regarding potential program/network improvement opportunities and needs
  • Conduct proactive outreach with external stakeholders (e.g., health care providers; health plan) to demonstrate the value of services and offerings
  • Collaborate with relevant internal and/or external stakeholders to resolve issues and obstacles with network/program/contract performance
  • Collaborate with the contracting team to ensure adherence to internal contracting standards
  • Communicate with applicable stakeholders to provide performance updates regarding program/contract implementation (e.g., objectives; goals; timelines; schedules; issues; performance against standard contract agreements)
  • Followup with stakeholders to ensure issues have been resolved and addressed effectively and timely
  • Manage external relationships with thirdparty vendors to ensure program SLAs are met
  • Demonstrate understanding of demographic systems (e.g., Emptoris; NDB)
  • Demonstrate understanding of claims platforms (e.g., Galaxy; COSMOS; NICE; FACETS; Diamond; PPOOne)
  • Demonstrate understanding of report generation and workflow management systems (e.g., ChartFinder; InSite; Sharepoint Documentation; Salesforce)
  • Demonstrate understanding of contracting strategies (e.g., facility; ancillary; physician) in order to support field objectives/MBOs
  • Demonstrate understanding of key provider/contract/network performance and/or risk adjustment indicators (e.g., prevalence rate; recapture rates; MWOV; RAF scores)
  • Demonstrate understanding of provider group operations and stakeholder/client business models
  • Demonstrate understanding of documentation and coding procedures (e.g., ICD9)
  • Demonstrate understanding of applicable health care regulations (e.g., HIPAA; ARRA; CMS)
  • Demonstrate understanding of operations of key business partners (e.g., Clinical Service; Medical Management; Health Care Economics)

Values Based Competencies

Leader

  • Integrity Value: Model and Ensure Ethical Behavior
    • Comply with Applicable Laws, Regulations and Policies
    • Demonstrate Integrity
    • Require Integrity and Ethical Behavior from Others
  • Compassion Value: Deliver Value to Customers
    • Maximize Customer Growth and Retention
    • Optimize the Customer Experience
  • Relationships Value: Lead and Develop People
    • Bring in the Right Talent
    • Develop People
    • Drive Employee Engagement
    • Foster Teamwork and Collaboration
    • Learn and Develop Self
    • Leverage Diversity and Inclusion
  • Relationships Value: Communicate Effectively
    • Communicate with Impact
    • Influence and Negotiate
    • Listen Actively
    • Present Effectively
  • Innovation Value: Lead Change and Innovation
    • Demonstrate Emotional Resilience
    • Implement Innovative Solutions
    • Manage Change
  • Performance Value: Drive Sound, Disciplined Decisions
    • Apply Financial Knowledge
    • Make Decisions to Drive Action
  • Performance Value: Drive HighQuality Execution
    • Communicate Clear Direction
    • Drive Operational Excellence
    • Manage Execution

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

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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