Provider Engagement Representative - Remote in NC or SC

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

Careers with OptumCare: Optum Care is a nationwide health care delivery organization that is reinventing health care, unlike anyone else in the market place, to help keep everyone healthier and feeling their best.

In all we do, we are committed to the quadruple aim - improving patient satisfaction, lowering costs, delivering quality outcomes and increasing provider satisfaction.

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)

The Provider Engagement Representative is responsible for the full range of provider relations and service interactions within Optum, including working on end-to-end provider claim and call quality, and training & development of external provider education programs. Provider Relations Advocates design and implement programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Responsibilities also include directing and implementing strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims.

If you are located in the state of North Carolina or South Carolina, you'll enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:
  • Assignment of, and on lead for a number of Skilled Nursing Facilities & Assisted Living Facilities to develop and maintain overall UnitedHealthcare business relationship
  • Support all education opportunities on UnitedHealthcare businesses which include in person and telephonic interactions
  • Lead and/or support external facing Account and business review meetings with key Skilled Nursing Facility staff
  • Provide explanations and information to others on topics within area of expertise
  • Prioritize and organize own work to meet deadlines cross functionally within the organization
  • Investigate non-standard requests and issues, prior to escalation if needed
  • Work exclusively within a specific knowledge area
  • Salesforce Data Base - update & maintain regularly with information following AR, Bus Review and JOC Meetings with facilities
  • Support Post-Acute Priorities
  • ISNP and IE-SNP Business Development- assist with planned growth initiatives for ISNP/IE-SNP business
  • Education and Training to facilities on Medication Adherence requirements for members
  • Provide outreach and education on updated policies, new initiatives, performance and others as necessary

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 or equivalent experience
  • 2+ years of provider relations and/or provider network experience
  • Ability to travel regionally up to 25%
  • Intermediate level of proficiency in claims processing and issue resolution
  • 1+ years of experience with Medicare regulations
  • Exceptional presentation, written and verbal communication skills
  • Ability to prioritize and meet deadlines
  • Intermediate level of proficiency with MS Word, Excel, PowerPoint and Teams

Preferred Qualifications:
  • Experience working in a Skilled Nursing or Assisted Living Facility
  • 1+ years of experience with Medicaid regulations
  • Experience with Salesforce databases

Careers with Optum. We built an entire organization around one giant objective; make the health system work better for everyone. 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 an elite team. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy

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 Engagement Representative, Skilled Nursing, Provider Relations, Medicare, Optum, Telecommute, Remote, Work from Home , Work at Home, WFH, WAH, #RPO