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The Senior Director of Network Programs is responsible for the successful program design, compliance with network requirements, network assessment and selection, and program/product implementation for the Senior Care Options product. This includes directing network strategies with the corporate network team for Home and Community Based services and other providers and services as well as direct responsibility for setting strategy, negotiation and implementation of provider and vendor contracts for and all nursing home and home and community based services across Massachusetts. This includes Plan- wide strategy development that focus on specific clinical areas and functions as well as new payment structures (e.g., care management services as product offering for ACOs, innovative value-based payment arrangements for traditional and non-traditional providers (e.g., HCBS and other LTSS) to improve quality, outcomes or financial results (revenue, reduction of medical expenses or IOI improvement). May perform network analyses and strategy development and implementation either directly or by directing the work of finance and accounting teams (e.g., setting assumptions for CFO, Actuarial or accounting staff when developing analyses). Makes recommendations regarding use, expansion, selection of networks for various products based on that analysis.
The Senior Director will work collaboratively with COO, VPs and Senior Directors in Health Services and Sales/Marketing to determine strategy and priorities and will direct the work of the local network management staff. Directors of Network Programs 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.
The position is responsible for ongoing provider relations, provider communications and provider satisfaction. Other responsibilities may also include making recommendations regarding use, expansion, selection of networks for various products based on that analysis. This position also has oversight for delegated vendor relationships. As department lead, Director will evaluate current business processes and policies, stakeholder feedback and market or regulatory needs to develop a department strategy and charter, make recommendations and decisions for organizational structure and resource requirements.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Preferred in Massachusetts.
- Develop and execute strategies for a function or discipline that spans a large business unit or multiple markets/sites
- Direct others to resolve business problems that affect multiple functions or disciplines
- Product, service or process decisions are most likely to impact multiple functions and/or customer accounts (internal or external)
- Be responsible for network strategy development and execution for long term services and supports, i.e., home and community based services, Aging Service Access Points (ASAPs), skilled nursing facilities and nursing homes
- Lead and motivate a team of experienced staff
- Oversee all Network Compliance requirements and submissions
- Oversee Benefit configuration related to SCO or One Care products
- Lead any state or CMS audits of the SCO or One Care provider network
- Health plan lead for all provider materials and communications, including editing/updating Provider Directories/Manuals, and development of material for distribution/communication at Town Halls, Provider Roundtables, Provider website updates
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.
- Undergraduate degree
- 8+ years of experience working with a managed care organization, health insurer, or consultant in a network management/contract management role, such as contracting, provider services, etc.
- 7+ years of experience working with healthcare and claims data
- 5+ years of experience managing staff, including directing functional business responsibilities, delegating and ensuring accountability, resolving conflict, providing constructive and appreciative feedback and mentoring and coaching staff
- 5+ years of experience with or strong knowledge/understanding of claims and other operational systems
- 3+ years of project management or project lead experience and managing matrix relationships
- 3+ years of experience with contract submission, validation and maintenance
- Advanced level of proficiency with SNF, Home and Community Based Services, facility/ancillary, value-based payments and other provider contract reimbursement methodologies
- Advanced proficiency in MS Office (Excel, Word and PowerPoint)
- Advanced knowledge of business processes that impact contract loading and auditing
- Advanced ability to convey complex or technical information in a manner that others can understand
- Demonstrated excellent communication skills, including proven ability to communicate effectively with various levels of leadership
- Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance
- Masters/MBA preferred
- Experience working with DSNP (Dual Special Needs Plan) or related
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. Preferred in Massachusetts.
Colorado Residents Only: The salary range for Colorado residents is $110,200 to $211,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives
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.
Based on the Federal mandate full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.
Job Keywords: Director, Senior Director, Network Programs, Massachusetts, MA, Telecommute, Remote, Work from Home