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.

The Specialist Network Program Manager with OptumCare is 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 specific clinical area Lines of Service (e.g., Cardiology, Women's Health, Oncology, etc.) 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.

If you live in Pocatello, Idaho Falls, Black Foot, or surrounding areas, you will have the flexibility to telecommute* as you take on some tough challenges. This position will require travel within Southern Idaho. Some of the counties that you may have to manage and or travel to include Jefferson, Madison, Bonneville, Bingham, and Bannock.

Primary Responsibilities:

• Predicts emerging customer needs and develops innovative solutions to meet them.
• Solves unique and complex problems with broad impact on the business.
• Participates in the development of business strategy.
• Develops and manages business plans to achieve objectives.
• Leads large, complex projects to achieve key business objectives.
• Translates highly complex concepts in ways that can be understood by a variety of audiences.
• Influences senior leadership to adopt new ideas, products, and/or approaches.
• 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 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, risk adjustment scores; prevalence rates; Unit Cost Reduction Trend) to determine which programs to implement and/or modify
• Research competitor and external information regarding key network characteristics and contracting strategies to develop products and programs
• Ensure relevant contract and demographic information is loaded into the applicable platform to support analysis and review
• Review and or analyze member/provider population information (e.g., cultural information; demographics; geographic coverage) 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 pay-for-performance programs (e.g., PBC; PCPI)
  

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:

• Bachelor’s Degree and or equivalent work experience
• 2+ years of experience working as a consultant in a network/contract management role, such as contracting, provider services, etc.
• 2+ years of experience in data analysis
• Demonstrated experience with making presentations to both small and large groups
• Intermediate proficiency with MS Suite (including Word, PowerPoint, and Excel)
• Access to reliable transportation and the ability to travel up to 50% (about twice a week) within Southern Idaho to places like: Owyhee, Camas, Blaine, Gooding, Lincoln, Jerome, Minidoka, Cassia, Twin Falls, Jefferson, Madison, Bonneville, Bingham, and Bannock.
  

Preferred Qualifications:

• 2+ years of project management or project lead experience
• 2+ years of experience working with claims systems
• 2+ years of experience with facility/ancillary contracts
• Expertise in physician/facility/ancillary contract reimbursement methodologies
• Understanding of medical financial statements and delivery systems, provider contracting, reimbursement arrangements, and network management
• Ability to manage multiple priorities and maintain an organized approach
• Established knowledge of local provider community
• Create business strategies through excellent analytical and problem-solving skills with effective follow through
• Exceptional interpersonal skills with ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives, and other health plan staff
  

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.

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.