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Provider Relations Consultant / LTC - HCBS Network Administrator - Phoenix, AZ - 2156575

Company: UnitedHealth Group
Location: Phoenix
Posted on: March 20, 2023

Job Description:

At UnitedHealthcare, 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 equitable. Ready to make a difference? Join us and start doing your life's best work.(sm) Provider Relations Consultant who is in Arizona and who manages and oversees network development, network sufficiency, and network reporting functions. This position ensures network adequacy and appointment access, develops network resources in response to identified unmet needs, and ensures a member's choice of providers. This position focuses on the LTC/HCBS network, providers serving members in this product, and ensuring compliance with regulatory requirements to support LTSS product contractual commitments. Primary Responsibilities:

  • Attend work group meetings with AHCCCS/other LTSS MCOs and disseminate updates and requirements back to team for implementation. This includes verifying implementation and ensuring delivery of any contractual artifacts. Number of meetings will vary by project. An average will be 4-6 standing meetings per month
  • Coordination, review, and submission of all scheduled and ad-hoc deliverables for AHCCCS to include, network adequacy and appointment availability access
  • Heavy dependency on SNF, HCBS and other contracting teams to supply data required for deliverables
  • Oversight for ensuring state required reimbursements and fee schedules (new and updates) (including DAP and Directed Payments) are implemented accurately and on time
  • Position coordinates with relies on applicable contracting teams for execution
  • Network lead to coordinate significant hands on work with providers to ensure compliance with CMS driven rules for HCBS. This will be heavily dependent on Quality, National Network, and Provider Advocates for execution of the provider education and other deliverables (Anticipate over 500 providers in scope for audits and targeted education)
  • Position will also work in concert with Corporate to develop provider education materials to educate the providers and execute on the plan
  • Serving as Network Lead for Operational Reviews and other Regulator Audits required for the LTSS product
  • Monitor compliance with requirements for Electronic Visit Verification (EVV) and assist in development of action plans as required
  • Works across Health plan to support LTSS Network Deliverables and Provider Trainings, including new provider types identified through market surveys and requirements to ensure a more robust LTSS network
  • Other LTC/HCBS network regulatory requirements to be determined, pending AHCCCS 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:
    • Undergraduate degree or equivalent work experience
    • 5+ years of health care/managed care experience
    • 5+ years of provider relations and/or provider network experience
    • 1+ years of experience with Medicare and Medicaid regulations
    • Proficiency with MS Word, Excel, PowerPoint and Access
    • Intermediate level of proficiency in claims processing and issue resolution
    • Reside within the Phoenix, AZ vicinity
    • Willing and able to work out of the Phoenix office Careers with UnitedHealthcare. Work with a Fortune 5 organization that's serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none. 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.

Keywords: UnitedHealth Group, Phoenix , Provider Relations Consultant / LTC - HCBS Network Administrator - Phoenix, AZ - 2156575, IT / Software / Systems , Phoenix, Arizona

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