279 Unitedhealth Group jobs in the United States
UnitedHealth Group Leadership Experience (ULE) Internship - Remote
Posted 1 day ago
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UnitedHealth Group Leadership Experience (ULE) Internship - Remote
Posted 5 days ago
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Job Description
At UHG, we've built focused businesses organized around one giant objective: making healthcare work better for everyone. Through our two business platforms, UnitedHealthcare (UHC) and Optum, we strive to improve the healthcare system and advance the health and well-being of individuals and communities. This includes the entire spectrum of healthcare participants: individual consumers, employers, commercial payers, intermediaries, physicians, hospitals, pharmaceutical and medical device manufacturers, and more.
For you, that means working on high performance teams against sophisticated challenges. It's a culture of optimism that's unlike any place you've ever worked. Incredible ideas in one incredible company.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
**Are you ready?**
The UnitedHealth Group Leadership Experience (ULE) provides select participants pursuing advanced degrees with superior, cohort-based exposure, experiences, and development opportunities through best-in-class intern and full-time programs, specifically designed to develop the next generation of leaders, requiring highly motivated, passionate individuals with bright ideas and the will to lead.
The ULE Internship is ten weeks long and delivered remotely, with the option to travel. Projects will vary by business and are scoped and assigned closer to Internship start. We offer full-time placement opportunities post-graduation, based on performance. The start date is June 2, 2026
**During your ULE internship experience, you will:**
+ Lead high-priority work that supports one of our core businesses
+ Gain exposure to and knowledge of the healthcare industry, Enterprise-wide businesses, functions, strategies, and senior leaders
+ Develop relationships and networks
+ Receive hands-on training and support
+ Leverage business acumen and work experience to drive transformation
+ Learn from and present to executives
+ Contribute to fun and engaging cohorts
+ Lay the groundwork for a meaningful and impactful career at UHG
**Examples of Intern projects:**
+ Build a comprehensive go-to-market strategy for UHG's Type-2 diabetes program for direct-to-consumer, risk-bearing entity (ACO), multi-payer, Medicare, and / or Medicaid channels
+ Complete a market sizing analysis, including MVP definition and product / capability requirements for a new product in service of Optum's Health organizations and consumers
+ Refine and implement the digital services plan for one of Optum's CDOs via the identification and strategic development of digital health initiatives and capabilities
+ Comprehensive health equity strategy that reduces geographic health disparities and addresses specific populations' (ex. behavioral health, individuals of childbearing age) outcomes
+ Market expansion strategy driven by data focused on geographical areas coupled with demographic information to make strategic decisions on smart growth through expansion, implementation and system readiness
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
+ Currently pursuing an MBA or other relevant graduate degree with a target graduation date no later than July 2027
+ 5+ years of previous professional work experience
+ Eligible to work in the U.S. without company sponsorship, CPT/OPT now or in the future, for employment-based work authorization (F-1 students with practical training and candidates requiring H-1Bs, TNs, etc. will not be considered)
**Preferred Qualifications:**
+ Outstanding academic achievement
+ Consulting and/or healthcare experience and/or involvement with consulting/healthcare clubs
+ Excellent interpersonal, influencing and communication skills at all levels
+ Practiced project management and navigating competing priorities
+ Demonstrated ability to articulate and solve complex problems through strategic, analytical and creating thinking
+ Adaptable and comfortable in ambiguity and high-impact situations
+ High emotional intelligence and capacity to GSD (get stuff done)
+ Champion of change and customer orientation
+ Learning/growth oriented
+ Aligned to UHG's values of Integrity, Compassion, Relationships, Innovation and Performance
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
_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._
_UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
Vice President, External Affairs, Pharmacy Care Services - UnitedHealth Group
Posted 6 days ago
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Job Description
**Key Responsibilities:**
The Vice President, External Affairs, Pharmacy Care Services (PCS), will position the Enterprise as a thought leader by shaping and informing our policy decisions and advocacy strategy related to pharmacy and prescription drug issues to advance our mission and modernize the health care system. The Vice President cultivates and partners with industry allies, influential stakeholder organizations, health care thought-leaders, and policymakers to advance shared pharmacy care services priorities. They shape and manage formal and informal advocacy coalitions and contribute to bipartisan relationships with legislators and executive branch officials to advance the Enterprise's pharmacy advocacy objectives and growth priorities.
The Responsibilities of the Vice President, External Affairs, Pharmacy Care Services include:
+ Proactively identify emerging business threats or opportunities and partner with business leaders across the Enterprise to manage priority pharmacy and prescription drug policy issues at the state and federal levels, including pharmacy benefit manager (PBM) reform efforts, prescription drug affordability, innovative care delivery for pharmacy services, and promoting value-based payment arrangements for prescription drugs.
+ Anticipate emerging pharmacy trends and work with leadership across UHC and Optum to prepare for responding to the trends to position the enterprise effectively. Partner across the business to identify and develop opportunities to help sustain and grow the business.
+ Have deep understanding of the pharmaceutical supply chain, FDA approval processes, coverage and reimbursement processes for prescription drugs, and familiarity with key prescription drug policy influencers across the Administration and Congress.
+ Produce thought leadership and advocacy materials and shape research deliverables to effectively communicate Enterprise positions.
+ Shape PCS advocacy and messaging strategies and help prepare business leaders for external engagements.
+ Partner with subject matter experts across Government and the private sector and shape coalition activities to proactively shape prescription drug policy discussions to advance Enterprise priorities.
+ Synthesize and communicate policy activities of interest - such as major regulations, legislation, hearings, and other activities - to Executive leadership and the Enterprise as a whole.
+ Collaborate with colleagues in advocacy, communications, research, public affairs, business, and other functions to ensure coordinated engagement and consistency of messaging.
+ Contribute to policy team-wide initiatives and contribute to policy development and advocacy efforts led by other policy team members.
+ Lead and manage internal working groups.
+ Supervise a policy team member.
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:**
+ Bachelor's degree.
+ A minimum of 10 years of health policy experience, including a minimum of 2 years of PBM and/or Drug Pricing Policy experience.
+ A demonstrated track record of successful engagement shaping legislation and regulations through negotiation with stakeholders and policymakers at the state and federal levels across all policy areas of interest to the Enterprise.
+ Excellent interpersonal skills, listen attentively, and build rapport and trust.
+ Superior oral and written communication skills with the ability to persuasively communicate complex concepts and programs at the highest levels of business and Government.
+ An ability to develop and maintain solid internal and external relationships while enhancing the company's positions.
+ Executive presence, dynamic professional style and the ability to inspire confidence in senior management and those outside the company.
+ Intellectual curiosity and ability to gather, assess, and synthesize information from various sources.
+ Proven track record of effectively directing and supervising internal teams and outside contractors.
**Preferred Qualifications:**
+ Master's degree
+ Experience working across a variety of sectors, including: the U.S. Congress or the Department of Health and Human Services or similar relevant agency, in-house with a corporation, consulting firm, or a leading industry association.
+ Demonstrated understanding of UnitedHealth Group businesses (organizational structure, business strategies, current initiatives, goals and objectives, global businesses).
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $196,600 to $337,100 annually based on full-time employment. We comply with all minimum wage laws as applicable.
_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._
_UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
Managed Care Compliance Specialist - Managed Care
Posted 1 day ago
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Managed Care Compliance Specialist - Managed Care
Posted 13 days ago
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Job Description
Job Description
The Managed Care Compliance Specialist is responsible for assisting with the implementation of the internal auditing and monitoring program within the Managed Care department by ensuring compliance with applicable rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHCS.
Duties and Responsibilities:
-
Ensures all services provided to Commercial, Medicare and Medi-cal managed care members are in compliance with program regulations, insurance regulations, and regulatory requirements.
-
Maintains and tracks laws and regulations, contract documentations, amendments, and various compliance measures pertaining to Commercial, Medicare and Medi-cal managed care.
-
Develops policies, procedures, and processes to align with federal program regulations and any applicable state regulations pertaining to Commercial, Medicare and Medi-Cal managed care.
-
Provides mentorship to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language for Commercial, Medicare and Medi-Cal managed care.
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Acts as a liaison with health plans and current CSHS departments to ensure both health plan regulations and CSHS policies are met.
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Coordinates and act as primary contact for all health plans audits, including leading all aspects of the review for performance management and accurate coding.
-
Develops and supervise compliance with corrective action plans as a result of post-health plan audits and regulatory audits.
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Provides required Compliance and FWA trainings for existing, new employees and non-employees, as the need arises.
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Educates CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc.
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Remains updated on all member and provider policy changes made by the health plan and/or the State.
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Acts as subject matter expert on health care laws/regulations as a compliance resource to CSHS and affiliates, including contracted and employed physician practices.
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Aggregates, analyze, and report audit results, identify error trends and root causes, and make recommendations for performance improvements.
Qualifications
Education:
High school diploma/GED required. Bachelor's degree in Healthcare or related field preferred.
Experience:
Five (5) years of compliance experience, preferably in a healthcare environment, required. Two (2) years of Medi-Cal, Medicare or Commercial Managed Care experience preferred.
About Us
Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents.
About the Team
With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai's medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond.
Req ID : 11981
Working Title : Managed Care Compliance Specialist - Managed Care
Department : MNS Managed Care
Business Entity : Cedars-Sinai Medical Center
Job Category : Strategic Plan / Business Dev
Job Specialty : Managed Care
Overtime Status : EXEMPT
Primary Shift : Day
Shift Duration : 8 hour
Base Pay : $34.69 - $53.77
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.
Managed Care Compliance Specialist - Managed Care
Posted 12 days ago
Job Viewed
Job Description
The Managed Care Compliance Specialist is responsible for assisting with the implementation of the internal auditing and monitoring program within the Managed Care department by ensuring compliance with applicable rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHCS.
Duties and Responsibilities:
+ Ensures all services provided to Commercial, Medicare and Medi-cal managed care members are in compliance with program regulations, insurance regulations, and regulatory requirements.
+ Maintains and tracks laws and regulations, contract documentations, amendments, and various compliance measures pertaining to Commercial, Medicare and Medi-cal managed care.
+ Develops policies, procedures, and processes to align with federal program regulations and any applicable state regulations pertaining to Commercial, Medicare and Medi-Cal managed care.
+ Provides mentorship to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language for Commercial, Medicare and Medi-Cal managed care.
+ Acts as a liaison with health plans and current CSHS departments to ensure both health plan regulations and CSHS policies are met.
+ Coordinates and act as primary contact for all health plans audits, including leading all aspects of the review for performance management and accurate coding.
+ Develops and supervise compliance with corrective action plans as a result of post-health plan audits and regulatory audits.
+ Provides required Compliance and FWA trainings for existing, new employees and non-employees, as the need arises.
+ Educates CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc.
+ Remains updated on all member and provider policy changes made by the health plan and/or the State.
+ Acts as subject matter expert on health care laws/regulations as a compliance resource to CSHS and affiliates, including contracted and employed physician practices.
+ Aggregates, analyze, and report audit results, identify error trends and root causes, and make recommendations for performance improvements.
**Qualifications**
**Education:**
High school diploma/GED required. Bachelor's degree in Healthcare or related field preferred.
**Experience:**
Five (5) years of compliance experience, preferably in a healthcare environment, required. Two (2) years of Medi-Cal, Medicare or Commercial Managed Care experience preferred.
**About Us**
Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents.
**About the Team**
With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai's medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond.
**Req ID** : 11981
**Working Title** : Managed Care Compliance Specialist - Managed Care
**Department** : MNS Managed Care
**Business Entity** : Cedars-Sinai Medical Center
**Job Category** : Strategic Plan / Business Dev
**Job Specialty** : Managed Care
**Overtime Status** : EXEMPT
**Primary Shift** : Day
**Shift Duration** : 8 hour
**Base Pay** : $34.69 - $53.77
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.
Managed Care Biller
Posted 1 day ago
Job Viewed
Job Description
Due to company growth, CommuniCare Health Services is currently recruiting a Managed Care Biller for our Corporate Managed Care Billing Department.
The position of Managed Care Biller/Collector is responsible for billing, receivables auditing, and collections activities for services provided to patients in the facilities assigned. Ultimately they are responsible for hitting their cash collection goals each month and minimizing the impact of Bad Debt for the buildings/facilities assigned to them.
All CommuniCare employees enjoy competitive wages and PTO (Paid Time Off) plans. We offer full time employees a menu of benefit options that include:
- Life Insurance and Disability Plans
- Medical, dental, and vision coverage from quality benefit carriers
- 401K with employer match
- Flexible Spending Accounts
Position Requirements:
- Knowledge of medical billing/collection practices.
- 3-5 years experience in managed care billing preferred
- Experience billing various Managed Care companies and understanding the requirements for each payor
- Claim appeal/resolution expertise preferred
- Must have a high degree of attention to detail.
- Strong verbal and written skills required in order to interact with insurance companies to resolve unpaid claims via telephone and written correspondence.
- Basic computer literacy and skills.
- Strong organizational skills a must.
About Us: A family-owned company, we have grown to become one of the nation's largest providers of post-acute care, which includes skilled nursing rehabilitation centers, long-term care centers, assisted living communities, independent rehabilitation centers, and long-term acute care hospitals (LTACH). Since 1984, we have provided superior, comprehensive management services for the development and management of adult living communities. We have a single job description at CommuniCare, "to reach out with our hearts and touch the hearts of others." Through this effort we create "Caring Communities" where staff, residents, clients, and family members care for and about one another.
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Managed Care Specialist
Posted 1 day ago
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Job Description
Our Client is looking to hire a Managed Care Specialist for a hybrid role.
No duplicate submissions
Our Client provides their workforce with a hybrid work environment. Most positions have a combination of work from home and work in the office, which varies by position, department, and business need. Training is extensive, up to 6 weeks prescheduled, virtual / in-office (by supervisor request), and contractors must attend training every day to build proficiency.
No Preplanned PTO will be approved during training weeks.
All candidates MUST be local to middle TN and able to commute to our Client's office in Nashville, TN as needed. The work hours and schedule are M-F with standard 7.5 hours per day/max, 37.5 hours per week.
Key Responsibilities
• Determine individual and family eligibility for our Client's care programs.
• ssist in coordinating and communicating schedules to internal/external Clients.
• Conduct client interviews, collect facts and information, and compile case data to provide recommendations to an attorney.
• Timely management of casework, including proper documentation and case resolution.
• Provide legal research, analysis of legal papers, and draft legal documents. Document findings accurately.
• Work efficiently / effectively in multiple databases to extract information.
• ttend workgroup meetings and participate in discussions.
• ssist leadership team, as necessary.
Requirements and Skills
• Must have a bachelor's or associate degree.
• background in Paralegal studies is a plus.
• Work experience in a Legal environment a plus.
• Customer service or call center experience a plus.
• Proven technical skills (e.g., Microsoft Word, Excel, Outlook, PowerPoint, SharePoint, etc.).
• Excellent time management skills with the ability to prioritize work to meet specific deadlines with minimal supervision.
• Excellent verbal and written communications skills.
• Keen attention to detail and adherence to deadlines.
• Strong time management, note-taking, email organization, and distribution skills.
• Critical thinking and problem-solving skills.
Other Important Information
• The position is a hybrid position in downtown Nashville, TN. The contractor will work onsite and remotely based on the team's schedule.
• The position is contract for 12 months with an opportunity to be extended.
Managed Care Specialist
Posted 1 day ago
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Job Description
Summary
Requisition ID
62077
Requisition Name
Legal Assistant
Quantity Requested
90
Submission Deadline
02/05/2024
Description
Our Client is looking to hire a Legal Assistant for an onsite role in their downtown Nashville, TN location.
No duplicate submissions.
Our Client provides their workforce with a hybrid work environment. Most positions have a combination of work from home and work in the office, which varies by position, department, and business need. However, this position is 100% onsite in their downtown Nashville, TN office.
Training is extensive, up to 6 weeks prescheduled, virtual / in-office (by supervisor request), and contractors must attend training every day to build proficiency.
No Preplanned PTO will be approved during weeks of training.
All Legal Assistant's MUST be local to middle TN and able to work in our Client's office in Nashville, TN as needed. The work hours and schedule are M-F with standard 7.5 hours per day/max, 37.5 hours per week.
Key Responsibilities
- Determine individual and family eligibility for our Client's care programs.
- Assist in coordinating and communicating schedules to internal/external Clients.
- Conduct client interviews, collect facts and information, and compile case data to provide recommendations to an attorney.
- Timely management of casework, including proper documentation and case resolution.
- Provide legal research, analysis of legal papers, and draft legal documents. Document findings accurately.
- Work efficiently / effectively in multiple databases to extract information.
- Attend workgroup meetings and participate in discussions.
- Assist leadership team, as necessary.
- Must have a bachelor's or associate degree.
- A background in Paralegal studies is a plus.
- Work experience in a Legal environment a plus.
- Customer service or call center experience a plus.
- Proven technical skills (e.g., Microsoft Word, Excel, Outlook, PowerPoint, SharePoint, etc.).
- Excellent time management skills with the ability to prioritize work to meet specific deadlines with minimal supervision.
- Excellent verbal and written communications skills.
- Keen attention to detail and adherence to deadlines.
- Strong time management, note-taking, email organization, and distribution skills.
- Critical thinking and problem-solving skills.
- The position is a 100% onsite contract in downtown Nashville, TN.
- The position is contract for 12 months with an opportunity to be extended.
Estimated Duration
05/20/2024 - 12/30/2024
Days
Monday Yes Tuesday Yes Wednesday Yes Thursday Yes Friday Yes Saturday No Sunday No
Hours/Day
7.5
Time Zone
CST
Shifts Start Time End Time Description
Active
Shift 1
8:00 AM
4:30 PM
State of Tennessee Official Standard Office Hours
Yes
Attachments File Description
Comments Comment Files Company Origin Viewable Created By Created On It is a 5-month Contract or 12 Months? CL Digital - Active Supplier Requistion ll Kumar, Pratham 01/09/2024 8:48 AM CST
Location
Position Location On Site
Address
310 Great Circle Rd. Nashville, Tennessee
Qualifications Type Category Qualification Description Competency Required Education Others Bachelor's or Associate Degree Must have a bachelor's or associate degree Proficient (4-6 Years) Yes Skills Others Critical thinking and problem-solving skills Proficient (4-6 Years) No Skills Others Communication Skills Excellent verbal and written communications skills. Proficient (4-6 Years) Yes Skills Others Microsoft Office Proven technical skills (e.g., Microsoft Word, Excel, Outlook, PowerPoint, SharePoint, etc.). Proficient (4-6 Years) Yes Skills Others Paralegal background in Paralegal studies is a plus. Novice (1-3 Years) No
Managed Care Specialist
Posted 1 day ago
Job Viewed
Job Description
13213 Enterprise Corporate - Payor Relations
Status:
Full time
Benefits Eligible:
Yes
Hou rs Per Week:
40
Schedule Details/Additional Information:
Weekdays
Job Summary
Manages administration of the contract portfolio and the day-to-day relationships between Carolinas HealthCare System (CHS) and Managed Care Organizations (MCOs) within that portfolio. Coordinates the financial, legal, operation and other administrative processes between the Systems and MCOs that are necessary to secure new contracts and maintain the viability of existing contracts. Supports designated leaders as assigned
Job Description
• Manages administration of the assigned portion of the contract portfolio.
• Maintains current detailed working knowledge of all assigned payor contracts, and manages all activities related to managed care contract administration and compliance including, but not limited to: Chargemaster Increases, Contract Rate Adjustments, Contract Critical Events, CHS Entity and Contract Database, and MHR document distributions.
• Creates and maintains electronic document database as well as original permanent files of all contract documents for all MCO contracts for Carolinas HealthCare System.
• Communicates and educates operational implementation of new contract terms that affect revenue cycle functions.
• Manages the implementation process for all new or renegotiated managed care agreements.
• Manages the secure distribution of confidential contract documents throughout CHS and communicates contract changes to executives, revenue cycle personnel and others within CHS.
• Monitors, reports, resolves and prevents operational issues related to existing managed care contracts. Routinely interacts with CHS revenue cycle staff and MCO provider relations to resolve any trended or escalated operational issues that arise during the term of the contract.
• Serves as advisor and point of contact for all CHS revenue cycle personnel for trended managed care operational and administrative issues. Supports the designated teammates and Managed Health Resources (MHR) Provider Services in their operational roles.
• Initiates and facilitates Joint Operating Committee (JOC) meetings with MCOs and facilitates internal meetings with CHS revenue cycle staff for issue resolution and contract performance improvement. Coordinates all JOC and operational meetings, creates and distributes the agenda, creates performance reports and meeting minutes.
• Reviews assigned payor websites and external information, staying current about changes to payor policies and other initiatives.
• Prepares clear, concise and focused internal communication/correspondence.
• Determines where to gather data based on requests; performs analyses and methodology application, under supervision, noting sources and methods.
Physical Requirements
Performs most work under normal office conditions; may include sitting for long periods of time, standing, walking, using repetitive wrist/arm motion or lifting articles up to twenty-five pounds.
Education, Experience and Certifications
Associate's degree or equivalent experience required. Minimum two years' experience in managed care contracting, operations, or patient financial services for large healthcare provider or managed care organization.
Patient Population Served
Demonstrates knowledge of the principles of growth and development and demonstrates the skills and competency appropriate to the ages, culture, developmental stages, and special needs of the patient population served.
Protected Health Information
• Will limit access to protected health information (PHI) to the information reasonably necessary to do the job.
• Will share information only on a need to know basis for work purposes.
• Access to verbal, written and electronic PHI for this job has been determined based on job level and job responsibility within the organization. Computerized access to PHI for this job has been determined as described above and is controlled via user ID and password.
Machines, Tools, and Equipment
Related office equipment and supplies.
Pay Range
$28.05 - $2.10
Our Commitment to You:
Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:
Compensation
- Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
- Premium pay such as shift, on call, and more based on a teammate's job
- Incentive pay for select positions
- Opportunity for annual increases based on performance
- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
About Advocate Health
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than 6 billion in annual community benefits.