Network Program Consultant - FACETS - Telecommute

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

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

You'll enjoy the flexibility to telecommute* from anywhere within United States as you take on some tough challenges.

Primary Responsibilities:
  • Oversee Medicaid and Medicare provider pricing research for new business implementations
  • Conduct market-based research using State websites, RFPs, and other State and competitor issued materials to ascertain all behavioral health pricing details
  • Develop and track all reimbursement edits that impact payable behavioral services within assigned Medicaid markets
  • Document pricing requirements for the purpose of efficient system configuration and conduct analytical sessions for configuration design with applicable teams
  • Develop all required fee schedules, facility pricing terms, and non-par pricing terms for assigned markets
  • Create all external and internal materials needed to conduct the network contracting and installation of the network
  • Research and document all benefit related edits for assigned markets
  • Interface with assigned testing teams to assist in script development and issue resolution for assigned markets
  • Interact with all applicable Program Teams assigned to new business implementations
  • Support the expansion of the Optum Behavioral Health Pricing Integrity Model for existing Medicaid business
  • Drive benefit through accurate and detailed pricing documentation and remediation
  • Ensure all partner teams are fully informed regarding market-based requirements that impact their teams (i.e. Claims, Medical Management, Provider Network Operations, and Network Management)
  • Support the facility contracting team with the development of the facility payment appendices to ensure they model the specific Medicaid payment methodology in the market
  • Support the transition of the documentation compiled into the appropriate steady state resource to ensure ongoing success of the installed pricing for an assigned market

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 Business, Finance, Health Administration, or related field and/or equivalent work experience
  • 4+ years of experience with behavioral (or medical) healthcare provider data and its business usage
  • 2+ years of experience with NetworX-FACETS platform
  • 1+ years of data analysis experience
  • Experience in drafting report or extract requirements or business rules
  • Claims processing familiarity on FACETS platform
  • Beginner to Intermediate proficiency with PC based software programs and automated database management systems required (Excel, Access, PowerPoint, Word)
  • Participation in one or more major projects, which integrate multiple business areas or systems

Preferred Qualifications:
  • 1+ years of technical writing experience is preferred along with effective time management and presentation skills
  • OHBS Facets, NDB and COSMOS experience or equivalent experience on another provider system
  • Claim processing / adjudication experience
  • Provider pricing methodology understanding. Includes FFS, Inpatient, Outpatient and Ancillary pricing methodologies

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.

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)

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $64,800 to $116,000. The salary range for Connecticut / Nevada residents is $71,400 to $127,400. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

*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: Network Program Consultant, FACETS, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH