Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
Positions in this function are 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 improving gaps in care, coding and documentation in the Primary Care provider offices to improve the quality and affordability through improvements in appropriateness and effectiveness. May perform network analysis and strategy development and implementation. 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. Impact of work is most often at the local level.
NOTEQualified candidates must reside in Kansas or Missouri to be considered – routine travel is required in this market
If you are located in Kansas or Missouri, you will have the flexibility to work remotely* as you take on some tough challenges
Primary Responsibilities:
* Develop action plans and priorities to improve quality outcomes
* Oversee network analysis and strategy development and implementation
* Drive program design and implementation to improve quality and affordability through improvements in appropriateness and effectiveness
* Ensure provider groups are obtaining, validating and analyzing data impacting network availability and access
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:
* Has a current, active Certified Risk Adjustment Coder Certification (CRC) and/or Certified Professional Coder Certification (CPC) with AAPC (NOTE: Qualified candidates must have at least one of the listed certifications at the time of application submission to be considered)
* 1 years of experience working with a managed care organization or health insurer; or as a consultant in a network/contract management role, such as contracting, provider services, etc.
* 1 years of experience in consulting
* 1 years of experience in data analysis
* 1 years of experience with claims systems
* 1 years of experience with ICD-10 coding
* 3 years of experience working directly with providers
* Proficient knowledge of Medicare Advantage including Stars and Risk Adjustment
* Be able to travel approximately 50% of the time in the assigned regional area as business needs dictate (Kansas and Missouri)
* Reside in Kansas or Missouri to be eligible for consideration
* Be able to provide proof of a valid, unrestricted Driver’s License and current Auto Insurance
* Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 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. Candidates must be able to perform all essential job functions with or without reasonable accommodation
Preferred Qualifications:
* Undergraduate degree
* Experience with HEDIS
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. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.
•All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
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.