[Hiring] Senior Provider Relations Advocate @UnitedHealth Group

Role Description

The C&S Long Term Care Division requires this position for servicing the LTC provider network, to include:

• Provider contracting, credentialing and re-credentialing
• Conducting provider relations tasks
• Providing education
• Working in the provider portal and EVV (electronic visit verification)
• Providing assistance with claims
• Ensuring network adequacy and closing gaps where necessary
• Network tracking and reporting
• Working with case management staff to assist with network needs for member benefits and services
• Working with SCAs and PNRs (Single Case Agreements and Provider Network Requests)

The Sr Provider Relations Advocate services in the capacity of Network Account Manager for managing the Florida SMMC business (Medicaid/Long-Term Care). Responsibilities include:

• Developing and maintaining the provider network (ancillary groups and home and community based service providers)
• Evaluating and negotiating contracts in compliance with company contract templates and reimbursement structure standards
• Establishing and maintaining strong business relationships with providers
• Ensuring appropriate distribution of Long-Term Care (LTC) and Home & Community Based (HCBS) specialties

This position will be located in Florida in the network servicing region. The goals of our LTC network team are to manage and carry out the provider network requirements for the Health Plan with the State regulator.

Job Scope and Guidelines:

• Generally work is self-directed and not prescribed
• Works with less structured, more complex issues
• Serves as a resource to others
• Assesses and interprets customer needs and requirements
• Identifies solutions to non-standard requests and problems
• Solves moderately complex problems and/or conducts moderately complex analyses
• Works with minimal guidance; seeks guidance on only the most complex tasks
• Translates concepts into practice
• Provides explanations and information to others on difficult issues
• Coaches, provides feedback, and guides others
• Acts as a resource for others with less experience

In this role you will be expected to:

• Apply basic knowledge of provider network functions
• Work in a fast-paced environment
• Have intermediate skill level in Microsoft programs (Teams, Outlook, Word, Excel, PowerPoint) and spreadsheet management
• Take initiative and use problem-solving skills for issue resolution
• Depend minimally on others for instruction, guidance or direction
• Be attentive to detail, work with flexibility, and have the capability of multi-tasking to meet deadlines and deliverables
• Possess knowledge in Medicaid and Long Term Care (Home and Community Based) programs
• Have good communication skills; and the ability to build and retain relationships with Provider/Ancillary providers
• Experience working with Health Plan contracts in compliance with company contract templates
• Display professional work ethics in a structured work environment
• Work in partnership with Sr Provider Relations Advocates and interact well with staff in cross-segment departments
• Perform other duties as required

Qualifications

• 5+ years working in a network management-related role, such as contracting or provider services
• 3+ years of experience in ancillary/facility/group credentialing, including knowledge of credentialing requirements for the State of Florida
• 3+ years working with provider/group Medicaid/Long Term Care contracts, claims, credentialing
• 3+ years of experience in performing network adequacy analysis
• Intermediate level of knowledge of Medicaid and Long Term Care reimbursement methodologies
• Intermediate level in Microsoft Word, Excel, PowerPoint, Access
• Reside in the Tampa SMMC Region D geographic area
• English-Spanish fluency without translation
• Excellent verbal and written communication skills
• Ability to work in a fast-paced ever-changing environment
• Solid interpersonal skills, establishing rapport and working well with others
• Solid customer service skills

Requirements

• Travel frequently throughout the Tampa Region or provider on-site visits (Hillsborough, Polk, Manatee, Hardee, Highland Counties)

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)
• Salary range from $72,800 to $130,000 annually based on full-time employment