Senior Network Analyst - Remote

Caring. Connecting. Growing Together.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.

This position is part of a team responsible for the review, response and completion of Health Plan, regulatory and internal audit activities. As a member of our network management team, you'll help ensure policies and procedures are compliant and current, evaluate and respond to network adequacy requirements, identify and correct errors within our contract management systems and/or respond to Health Plan and Regulatory Audit requests as required. Primary Responsibilities include research into relevant systems to obtain necessary documents and/or data. You will review contract documentation and interpret key language provisions or Compliance Requirements as set forth by Regulatory teams, leadership and legal advice and incorporate such information into Audit responses. Research and obtain relevant data for network adequacy review and analysis. May include auditing contract loads for adherence to quality measures and reporting standards This is a fast-paced, complex organization that requires building relationships and navigating across various departments as you review open inventory, research current status and opportunities and craft plans to reduce and/or resolve open audit and risk.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Monthly regulatory reporting to DMHC and Health Plans as required using Optum data sources and outside programs
• Perform comprehensive research and analysis using Excel and other reporting systems to evaluate compliance with network adequacy requirements and to facilitate the remediation of any identified issues
• Assist with internal and on-site audits of provider payments
• Respond to and complete Payor and other Regulatory (DMHC, CalOptima, LA Care, etc). audit requests on behalf of Network Services. Includes ability to review and interpret Contract and Compliance language to ensure appropriate responses
• Solve moderately complex problems and/or conduct moderately complex analyses
• Respond to requests using internal resource systems including email, Salesforce, Smartsheet, IDX, Symplr, Microsoft Office tools including Teams and Outlook
• Uses pertinent data and facts to identify and solve a range of problems within area of expertise
• Communicate with Care Delivery Organizations (CDO)
• Prioritizes and organizes own work to meet deadlines
• Work is frequently completed without established procedures
• Works independently
• Coordinates work activities with other teammates
• Identifies and resolves operational problems using defined processes, expertise, and judgment
• Decisions are guided by policies, procedures, and business plan

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:

• 4+ years of experience in the managed care industry, preferably in a network management, auditing, contracting or provider support role
• 1+ years of experience performing network adequacy analysis and building knowledge of CMS, DCHS and DMHC requirements
• 1+ years of experience with contracting applications (diCarta, Contract Manager, Purchasing Calendar and CCI Submission Databases, Salesforce, Symplr)
• Knowledge of the California managed care market
• High Proficiency with Microsoft Excel, Word and Access
• Ability to work PST hours

Preferred Qualification:

• Medical coding experience

Functional Competencies:

• Demonstrate understanding of applicable computer systems/platforms (e.g., Salesforce, IDX, Smartsheet etc.)
• Demonstrate understanding of relevant software applications (e.g., SharePoint; Outlook; Excel; Word)
• Demonstrate understanding of internal operations, workflow, policies, and procedures
• Seek additional information from internal partners (e.g., account management; legal) to clarify discrepancies and/or gather missing information
• Review submitted information to identify potential missing/inconsistent information
• Submit information to internal subject matter experts (e.g., claims) to identify tasks that need to occur to install/implement contracts
• Provide updates and feedback to customers on issues/amendments/progress regarding implementation

All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

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 $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.