Position Description: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 NetworkRecruiter is responsible for a full range of provider relations and serviceinteractions. They will works with the Director of Behavioral Health Networkand Manager of Provider Services on identifying network gaps, needs, andrecruitment strategies; identify and execute processes needed to recruitapplicant; work with Provider Network Department staff to align recruitmentefforts and maintain and ensure the integrity of provider databases; andrespond to provider inquiries with exceptional customer service to providers,County partners, peers, staff in other departments and the general public. As part of this position, you will be required to be granted and maintain access to the County of San Diego's electronic health record, Cerner Community Behavioral Health (CCBH ). In addition please note that if you are currently employed by the County of San Diego, further review of your application will need to occur to ensure that there is not a conflict of interest.Primary Responsibilities:Accountable for a full range of provider relations including engagement with and development of prospective providersDesign and implement strategies to increase the membership of providers in the networkCreate and execute a marketing plan to build and nurture provider network Identify needs in provider network, incorporating potential gaps related to composition, services, or geographical needsSupport leadership in establishing and maintaining strong business relationships with Hospitals, Physicians, Pharmacies and Ancillary providers, and ensure the network composition includes an appropriate distribution of provider specialtiesIdentify, coordinate and participate in outreach events to educate community providers on the benefit of network membershipEstablish recruiting requirements by studying organization plans and objectives and meeting with managers to discuss needsBuild applicant sources by researching and contacting community services, colleges, employment agencies, recruiters, media, and internet sites and provide organization information, opportunities, and benefits while making presentations and maintaining rapportAttract applicants by placing job advertisements, contacting recruiters, using newsgroups or job sitesImprove organization attractiveness by recommending new policies and practices, monitoring job offers and compensation practices, and emphasizing benefits and perksUpdate job knowledge by participating in educational opportunities, reading professional publications, maintaining personal networks, and participating in professional organizationsMust possess the following skills-Phone and Interviewing Skills , Recruiting, , People Skills, Strong decision-making, Professionalism, Good Judgment, Organizational Skills, Project ManagementSupport Diversity, Knowledge on Employment Law, Focus on Results Assume additional responsibilities as assignedAdditional Responsibilities may include:Complete administrative processes related to the application, credentialing, contacting and re-credentialing of providersReview all provider applications and documents to ensure compliance with the credentialing criteria for inclusion in the different networks Track credentialing process and send provider the completed contract once process is completeRun reports from provider databases to track credentialing and re-credentialing activities for a variety of provider typesReturn the signed fully executed contract to new providers in the Fee For Service and TERM networksTrack providers' malpractice insurance, DEA, and licensure renewals to ensure they are current/activeFacilitate the resolution of credentialing issuesCoordinate and complete external and internal termination notification requirementsPeriodically review state and federal bulletins for provider sanctions and review provider disbarment reports notifying Manager of outcomeAttend and participate in meetings to achieve departmental and interdepartmental goals and objectivesTriage provider related issues and escalate complex problems when necessary to ManagerRespond to claim issues by assessing fee schedule and contract configuration, procedure and diagnosis code questions, review modifiers and other claim form components in order to determine payment accuracyOrganize provider files so they may be easily reviewed by staff, credentialing committee and external review bodiesAccurately enter and maintain Provider data in multiple databases to be used for directories, payments, mailing labels and reportsDocument communication with providers in designated databases; assist in managing the integrity of databases by using contacts with providers to verify and update provider files
Requirements:High School diploma/GEDPrevious experience in managed care credentialing and/or network recruitmentExcellent computer skills including Excel, MicrosoftWord, OutlookAccess to reliable transportation during standard business hours.Preferred Qualifications:Associates Degree of higher Data entry experienceExperienceworking in an environment that requires coordination of benefits and working with multiple groups and resources Previous experience ins behavioral healthPrevious sales experienceCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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.SMDiversity 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.Keywords: UHG, Behavioral Health Provider Network Recruiter, San Diego, CA, County of San Diego, network recruitment, managed care, behavioral health
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.