The Behavioral Health Network Director is responsible for compliance with network requirements, network assessment and selection, and operationally managing the network department staff on a day to day basis. The Behavioral Health Network Director may perform network analysis; verify validity of data, and analyze data as required, in order to assure network availability and access for members. The Director will interface with executive level staff at UHC Community and State plan, in addition to executive level members of TennCare state officials. Interface with various departments within Optum and UHC Community and State plan, to include quality improvement, compliance, TennCare Behavioral Executive Director, and claims as necessary to support initiatives and to meet compliance, regulatory, and quality improvement requirements. If you are located in Tennessee, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities: Responsible for managing the network provider relations and contracting staffSet team direction, resolve problems and provide guidance to members of the teamAdapt departmental plans and priorities to address business and operational challengesInterface with claims analyst, claims department, and providers in resolving claims issuesResponsible for managing all TennCare Medicaid contract deliverables; meeting with the State of TN, Health Plan staff and potential and contracted behavioral health providersConduct regular staff meetings with teamAttend all meetings related to TennCare issuesDevelopment and maintenance of network policies, procedures, and standard operating procedure documentsResponsible for producing network reports critical to TennCare requirements
Required Qualifications: Undergraduate degree or equivalent work experience5+ years experience working with a managed care organization, health insurer, or consultant in a network management / contract management role, such as contracting, provider services, etc.3+ years experience managing staffIntermediate level of proficiency with all facility / ancillary contract reimbursement methodologiesAbility to convey complex or technical information in a manner that others can understandAdvanced proficiency in Medicaid policy and regulationsAdvanced proficiency in Behavioral Health concepts and methodologies Intermediate proficiency in MS Office (Excel, Access and PowerPoint)Travel will be required within the state of TennesseePreferred Qualifications:Knowledge and experience with TennCare MedicaidPreferred residence in the state of Tennessee or neighboring statePotential telecommuter opportunityExcellent organization skills with ability to multitaskExcellent communication skills, including ability to communicate effectively with various levels of leadershipCareers 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) *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, network, contract management, provider contracting, provider services, reimbursement methodologies, Medicaid, TennCare, travel, behavioral health, Brentwood, TN, Tennessee, telecommute, telecommuter, remote, work from home
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.