Senior Provider Relations Advocate - Riverside County, CA

Optum; Riverside (CA); On-site; USD 73,000 - 130,000; Full time

Benefits offered by this job

401k plan

Equity stock purchase

Job summary

Optum seeks a Senior Provider Relations Advocate to support its IPA physician network across South Riverside County, including Murrieta. The role requires travel 50-75% and in-office work 1–2 days weekly.

You will educate, troubleshoot and partner with IPA leadership to improve performance, access and care coordination. Strong communication and Medicare/Medi-Cal knowledge are essential for success.

Qualifications

• 3+ years in health care/managed care environments.
• 3+ years in provider relations and/or provider networks.
• Knowledge of Medicare and Medi-Cal regulations.
• Experience with healthcare system billing and claims processing.

Responsibilities

• Serve as single point of contact for the physician network and address provider needs.
• Monitor performance of PCPs and develop action plans with IPA leadership.
• Intervene and escalate issues as appropriate.
• Maintain awareness of providers for new business opportunities and market dynamics.
• Collaborate with offices and growth teams to drive membership growth and retention.
• Respond to provider issues within one business day and coordinate resolution.
• Build relationships with IPA physicians and staff; attend in-person meetings.

Skills

Healthcare experience

Provider relations

Medicare/Medi-Cal regulations

Billing understanding

Claims processing

Microsoft Office

Verbal and written communication

Travel willingness

Tools

CRM systems

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Senior Provider Relations Advocate - Riverside County, CA (2384793)

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

Optum is redefining health care with a focus on health equity, affordability, quality, and convenience. We are focused on helping patients live healthier lives and helping the health system work better for everyone. At Optum , we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

As a Senior Provider Relations Advocate at Optum, you will act as a direct interface between Optum and the affiliated physicians in Optum’s Independent Physician Association (IPA) network and support their operations and performance success. This position provides continuous education, support, training and troubleshooting to physicians and their staff.

The office hub for this position is located in Murrieta, CA. This position will require regular travel across South Riverside County including but not limited to Murrieta, Hemet, Temecula, Lake Elsinore, Wildomar, Menifee.

Primary Responsibilities:

• Serve as single-point-of-contact to the physician network and is an accountable owner, responsive to physician needs. Knowledgeable about incentive programs, contract reimbursement, Optum’s internal processes and priorities, and other Optum initiatives, as applicable
• Monitors performance of assigned PCPs, identifies low performing PCPs and works with IPA leadership to develop action plan for specific metrics needing improvement. Works with office to effectuate action plans and monitors progress
• Intervenes and escalate issues as appropriate
• Maintains awareness of providers interested in further engaging with Optum on new business opportunities (contracts and business combinations), and on shifting market/competitive dynamics that would impact the IPA
• Works collaboratively with offices and Optum growth team to drive membership growth and retention
• Responds timely (within one business day) to provider issues, works with other groups/central departments to resolve issues and updates providers and office staff regularly through to resolution
• Build collaborative relationships with IPA physicians and their office staff
• Attend in person department and training meetings at corporate locations as directed

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:

• 3+ years of health care/managed care experience
• 3+ years of provider relations and/or provider network experience
• Experience with Medicare and Medi-Cal regulations
• Proven understanding of healthcare systems billing
• Intermediate level of proficiency in claims processing and issue resolution
• Intermediate level of proficiency with Microsoft Office applications
• Proven excellent verbal, written and interpersonal skills required, including experience drafting correspondence and preparing meeting documentation
• Ability and willing to work an office-based schedule (in the office 1-2 days per week when not in the field)
• Ability and willing to travel 50-75% within assigned territory
• Driver’s License and access to reliable transportation

Preferred Qualifications:

• Provider recruitment and contracting experience

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

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.