Network Program Consultant - Albuquerque, NM

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The Network Performance Consultant is responsible for provider performance management which is tracked by designated provider metrics, STAR gap closure and coding accuracy. The person in this role is expected to work both internally and externally with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results. The person will review charts (paper and electronic - EMR), and look for gaps in care.

Primary Responsibilities:
  • Execute applicable provider incentive programs for health plan
  • Assist in the review of medical records to highlight Star opportunities for the medical staff
  • Activities include data collection, data entry, quality monitoring, upload of images, and chart collection activities
  • Locate medical screening results/documentation to ensure quality measures are followed in the closure of gaps
  • Establish positive, long-term, consultative relationships with physicians, medical groups
  • Develop comprehensive, provider-specific plans to increase their HEDIS performance and improve their outcomes
  • Provide ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
  • Act as lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation
  • Training will include Stars measures (HEDIS/CAHPS/HOS/med adherence), and Optum program administration, use of plan tools, reports and systems
  • Coordinate and lead Stars-specific monthly meetings with provider groups with regular frequency to drive continual process improvement and achieve goals
  • Provide reporting to health plan leadership on progress of overall performance, gap closure, and use of virtual administrative resource
  • Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
  • Provide suggestions and feedback to Optum and health plan
  • Organize and manage time and resources, establish priorities and coordinate work on multiple tasks simultaneously
  • Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members
  • Monitor provider financial performance to identify opportunities to improve performance and/or provider relationship
  • Monitor and/or oversee network performance and industry trends to identify opportunities to refine, develop, and/or implement market strategies
  • Other 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:
  • Bachelor's Degree in related field
  • Related education and experience may be substituted for one another on a year for year basis
  • 5+ years of experience with network contracting in a managed care environment
  • Network Data Experience - contracts/rates/configuration
  • Operations/claims experience
  • Understanding of and utilize applicable financial tools (e.g., HPM; PPM; FAT; HCE's RVU/Unit tool) and reports (e.g., internal financial models; external reports) to develop rates
  • Ability to utilize appropriate contract management systems (e.g., Emptoris; PEGA; Contract Attachment Repository) to author and execute contracts and to access supplemental contractual documents
  • Understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changes
  • Understanding of competitor landscape within the market (e.g., rates; market share; products; provider networks; market intelligence; GeoAccess)
  • 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

Preferred Qualifications:
  • STARs experience
  • Experience with EMR's
  • Experience in managed care working with network and provider relations/contracting
  • Medical/clinical background
  • Knowledge of the Medicare market
  • Knowledge base of clinical standards of care and preventive health
  • Financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)

Physical Demands:
  • Ability to stand occasionally
  • Ability to sit occasionally
  • Ability to walk occasionally
  • Kneeling/Crouching rarely
  • Lifting rarely
  • Ability to lift 10lbs


To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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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: Network Performance Consultant, Performance Consultant, Consultant, network contracting, Albuquerque, NM, New Mexico

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