Overview

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm) WellMed provides concierge – level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient’s health. WellMed’s proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella. Positions in this function are responsible for the successful implementation and adherence to program design, compliance with network requirements, network assessment and selection, and program/product implementation. This includes compliance, contracting, wrap around services, integrations with programs and systems, training and education, and health plan goals and priorities. May perform network analysis and strategy development and implementation. Obtains data, verifies validity of data, and analyzes data as required. Analyzes network availability and access. Makes recommendations regarding use, expansion, and deployment based on that analysis. Primary Responsibilities: Lead market network strategy development using resources, continued education, development and data. Assist in developing of strategic initiatives relating to provider networks, including service area expansions, new payment and incentive programs, risk arrangements, and new products. Works with the central team to develop and maintain a comprehensive provider network that meets CMS access standards and deliver a full range of healthcare access points for our members. Facilitate contracts with providers in collaboration with our contracting team to ensure quality, cost effectiveness and their participation in WellMed products and services. Analyze, plan, and assure provider network adequately meets CMS access standards. Ensure decisions made at the network level meet compliance and legal standards for WellMed. Develop and implement new provider programs to improve the delivery of services for members which are consistent and cost effective. Responsible for implementation and consistent tracking market-based decisions made at the central level. Inform and guide market leaders in making strategic, evidence based decisions. Performs all other related duties as assigned. 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: Masters of Business Administration Degree or 5 years of Equivalent Experience Demonstrate understanding of enterprise systems Demonstrate understanding of claims platforms 3 years’ experience working in Managed Care 3 years’ experience writing and implementing Standard Operating procedures Demonstrate understanding of operations of key business partners (e.g., Clinical Service; Medical Management; Health Care Economics) Advanced understanding of applicable health care regulations (e.g. HIPAA ARRA; CMS) 3 years’ experience working with risk adjustment and managing risk relationships in managed care Preferred Qualifications: Experience managing remote teams Experience integrating new markets with existing technology. Demonstrate understanding of report generation and workflow management systems (e.g., ChartFinder; Sharepoint, Salesforce) Demonstrate understanding of contracting strategies (e.g., facility; ancillary; physician) in order to support field objectives. Demonstrate understanding of key provider/contract/network performance and/or risk adjustment indicators (e.g., prevalence rate; recapture rates; MWOV; RAF scores) Demonstrate understanding of provider group operations and stakeholder/client business models Demonstrate understanding of documentation and coding procedures (e.g., ICD-9) Careers with WellMed. Our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. We’re impacting 380,000 lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We’ve joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life’s best work.(sm) 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. Job Details Requisition Number Job Title Director, Network Programs – Houston, TX Job Family Network Management Business Segment OptumCare Job Location Information Houston, TX United States North America Additional Job Detail Information Employee Status Regular Schedule Full-time Job Level Director Shift Day Job Travel No Telecommuter Position No Overtime Status Exempt