Director, Provider Relations & Network Management - Remote in ID

Network Director

At United Healthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

The Network Director is responsible for the full range of provider engagement and adequacy strategies. The Network Director will design and implement programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. This role will oversee and seek to improve and simplify end-to-end provider experience including service interactions, appeals and complaints, and general relationship status.

Position in this function responsibilities also include directing and implementing strategies relating to the management of a provider network, identifying gaps in network composition and services to assist the network contracting. This may also include identifying and remediating operational short-falls and researching and remediating claims. The Network Director will spend time connecting with providers directly, both virtually and in person, and assimilating and analyzing data to gain better visibility into provider experience.

This is a fast-paced working environment that requires the ability to multitask with attention to detail and excellent organizational skills.

This is an Idaho-based position, and you will have the flexibility to work remotely
* as you take on this challenging and rewarding work.

Primary Responsibilities:

• Manage provider complaints to resolution when initiated through regulators. Report status updates to IDHW and providers, as needed. Implement solutions that educate network on how to resolve issues with UHC resources
• Proactively partner with providers to identify opportunities for improvement, opportunities for growth and collaboration, and to gain general feedback regarding provider experience
• Partner with the COO to investigate and solve operational challenges. Report status updates to IDHW and providers, as needed. Maintain consultative and collaborative approach with providers through resolution
• Engage in onsite visits with providers. Utilize data analysis to determine the best strategy to choose which providers should be visited. Factors may include complaints, claim volume, attribution, quality measures, overlap with other teams, etc.
• Manage regulatory reports for the Idaho network. Partner with technical and functional teams to compile and audit reports
• Manage HCBS Provider Advocates (2), Workforce Development Administrator, Credentialing Coordinator, and Provider Claims Educator, which includes coaching, mentorship, collaboration, auditing and monitoring, establishing development and career planning, and more
• At least monthly, facilitate meetings with all provider-facing teams including, but not limited to provider relations, network contracting, growth, quality, and subcontractor provider teams
• Attend key provider conferences
• Show leadership with subcontractors who manage provider networks, including dental and vision
• Lead and facilitate meetings with providers and provider groups including IHA and other provider meetings where regulators are present. Attend and contribute to other virtual provider meetings
• Attend assigned advisory committees and contribute to the conversation showing leadership and subject matter expertise about our provider experience
• Partner with other provider teams to build expertise and relationships including credentialing, contracting, provider education, etc.
• Partner with providers in the adoption of enterprise tools that reduce administration, including but not limited to POCA (Point of Care Authorizations)
• Monitor Provider NPS with a focus on improvement
• Oversee provider communications, including the following:
  • Manage annual update and publication of provider manual
  • Participate in quarterly provider newsletter production
  • Conduct provider website review monthly and partner with…