Job 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 thats improving the lives of millions. Here, innovation isnt about another gadget, its about making health care data available wherever and whenever people need it, safely and reliably. Theres no room for error. Join us and start doing

your lifes best work.(sm)

The Network Program Manager 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 programs or initiatives, to improve the quality and affordability through improvements in appropriateness and effectiveness. Network Program Manager may perform network analysis and strategy development and implementation obtain data, verify validity of data, and analyze data as required, and analyze network availability and access. Other responsibilities may also include making recommendations regarding use, expansion, selection of networks for various products based on that analysis.

Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities
* Perform initial and concurrent review of inpatient cases applying MCG criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination
* Discuss cases with facility healthcare professionals to obtain plans-of-care
* Collaborate with UnitedHealthcare Medical Directors on performing utilization management
* Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level
* Consult with the Medical Director as needed for complex cases and make appropriate referrals to sister segments
* Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
* Identify delays in care or services and manage with MD
* Follow all Standard Operating Procedures in end to end management of cases
* Obtain clinical information to assess and expedite alternate levels of care
* Facilitate timely and appropriate care and effective discharge planning
* Participate in team meetings, education discussions and related activities
* Maintain compliance with Federal, State and accreditation organizations
* Identify opportunities for improved communication or processes
* Participate in telephonic and in-person staff meetings
* Build and maintain relationships
* Gather clinical information to assess and expedite care needs
* Maintain appropriate and accurate documentation

Youll 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 job experience equivalent
* 3 years ofexperience with network data management in a managed care environment
* Demonstrated ability to convey complex information to others and make it more easily understood
* Demonstrated ability to prioritize multiple tasks in an environment of rapid change
* Intermediate proficiency in MS Office (Excel, Access and PowerPoint)
* If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
Preferred Qualifications
* 1 years of Medicare Advantage experience, risk adjustment, HEDIS, and working closely with providers in these areas
* 3 years of experience with claims processing systems and provider databases
* 3 years of experience in provider data analysis and communicating metrics
* Excellent communication skills, including ability to communicate effectively with various levels of leadership
Careers with Optum. Heres 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 worlds 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 lifes best work.(sm)

Colorado Residents OnlyThe salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirementsHealth, dental, and vision plans wellness program flexible spending accounts paid parking or public transportation costs 401(k) retirement plan employee stock purchase plan life insurance, short-term disability insurance, and long-term disability insurance business travel accident insurance Employee Assistance Program PTO and employee-paid critical illness and accident insurance.
* All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

Diversity creates a healthier atmosphereUnitedHealth 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.

Job KeywordsNetwork Program Manager, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote

Requisition Number:933156

Business Segment:Optum Care Delivery

Employee Status:Regular

Job Level:Individual Contributor

Travel:No

Country:US

Overtime Status:Exempt

Schedule:Full-time

Shift:Day Job

Telecommuter Position:Yes