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Behavioral Health Network Director - Multiple Locations - 731194
at UnitedHealth Group
The Behavioral Health Network Director is responsible for compliance with network requirements, network assessment and selection, and operationally managing the network department staff on a day to day basis. The Behavioral Health Network Director may perform network analysis; verify validity of data, and analyze data as required, in order to assure network availability and access for members. The Director will interface with executive level staff at UHC Community and State plan, in addition to executive level members of TennCare state officials. Interface with various departments within Optum and UHC Community and State plan, to include quality improvement, compliance, TennCare Behavioral Executive Director, and claims as necessary to support initiatives and to meet compliance, regulatory, and quality improvement requirements.
Responsible for managing the network provider relations and contracting staff
Set team direction, resolve problems and provide guidance to members of the team
Adapt departmental plans and priorities to address business and operational challenges
Interface with claims analyst, claims department, and providers in resolving claims issues
Responsible for managing all TennCare Medicaid contract deliverables; meeting with the State of TN, Health Plan staff and potential and contracted behavioral health providers
Conduct regular staff meetings with team
Attend all meetings related to TennCare issues
Development and maintenance of network policies, procedures, and standard operating procedure documents
Responsible for producing network reports critical to TennCare requirements
Undergraduate degree or equivalent work experience
5+ years experience working with a managed care organization, health insurer, or consultant in a network management / contract management role, such as contracting, provider services, etc.
3+ years experience managing staff
Intermediate level of proficiency with all facility / ancillary contract reimbursement methodologies
Ability to convey complex or technical information in a manner that others can understand
Advanced proficiency in Medicaid policy and regulations
Advanced proficiency in Behavioral Health concepts and methodologies
Intermediate proficiency in MS Office (Excel, Access and PowerPoint)
Travel will be required within the state of Tennessee
Knowledge and experience with TennCare Medicaid
Preferred residence in the state of Tennessee or neighboring state
Potential telecommuter opportunity
Excellent organization skills with ability to multitask
Excellent communication skills, including ability to communicate effectively with various levels of leadership
Careers with Optum. Here's 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 world's 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 life's best work.(sm)
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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 Keywords: provider, network, contract management, provider contracting, provider services, reimbursement methodologies, Medicaid, TennCare, travel, behavioral health, Brentwood, TN, AR, KY, NC, GA, AL, MS, telecommute, telecommuter, remote, work from home