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The Behavioral Health Practice Performance Consultant will be responsible for supporting the state regulatory gold card programs and the national gold card program. The role will monitor for state requirement and parity compliance updates, facilitate ongoing program management with impacted teams and departments, and manage communications to providers and other groups. The Behavioral Health Practice Performance Consultant will also evaluate program impact through the use of provider analytics. This role will work closely with Clinical Operations, Claims, Communications, Provider Relations, Legal, Compliance, Health Care Economics, and UHC counterparts to ensure compliance with required gold card programs.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
- Develop a level of expertise around state regulatory and national gold card programs and associated requirements for behavioral health
- Monitor and manage programmatic needs of established gold card programs
- Coordinate with key stakeholders across the enterprise to identify challenges and develop solutions for established programs
- Manage analytics for each program to align to reporting requirements
- Ensure all provider communications are completed in accordance with program requirements
- Respond to provider and other stakeholder inquiries
- Utilize analytics to evaluate program impacts
- Implement interventions with providers as appropriate, based upon state and national program guidelines
- Will partner with other departments and teams in the following manner:
- Establish recurring status meetings for each state regulatory program and the national gold card program, coordinate with stakeholders around identified gaps or issues for resolution
- Evaluate regulatory requirements and updates to ensure analytics and exemption results are compliant, and manage all communications as specified by program or enterprise need
- Interface with other Optum departments including Clinical Operations, Provider Relations and Contracting, Legal, and Program and Network Integrity as appropriate
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
- License must be independent, active and unrestricted
- 3+ years of utilization review/utilization management experience in a managed care setting
- Experience interpreting data, identifying trends, and making data-driven decisions
- Proficient in Microsoft Excel
- Experience communicating (verbal and written) to various stakeholders, senior leaders and providers
- Experience managing multiple projects/responsibilities, meeting deadlines, and prioritizing tasks effectively
- Experienced in establishing and maintaining strategic relationships with leadership teams and key stakeholders
- Dedicated home office space and ability to leverage existing reliable high-speed internet (Cable Broadband, DSL, or Fiber)
Preferred Qualifications
- Knowledge of CPT/HCPCS codes
- Experienced in creating and delivering presentations to various levels/key stakeholders
- Experience in provider engagement, relationship management
- Experience auditing of medical records
- Proficient in PowerPoint
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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.
Diversity creates a healthier atmosphere: OptumCare 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
