CA Provider Capitation Requirements and Implementation - Remote

$88,000 - $173,200/Yr

UnitedHealth Group - Minnetonka, MN

Full-time

Remote - Minnetonka, MN

Insurance Carriers and Related Activities

About the position

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Responsibilities

• Assesses and interprets customer needs and requirements
• Makes recommendations and decisions for loading strategy for new market/payor configuration in Facets
• Gather technical and business requirements and responsible for documentation of business and process requirements
• Serve as primary subject matter expert to critically assess impact of non-standard implementation requests to claims and payment teams
• Act as escalation lead for identified risks; work with operational areas to develop and execute risk mitigation plans
• Maintain and foster collaborative working relationships with external stakeholders, internal SMEs, vendors and internal team members
• Coordination and completion of readiness tasks, timelines, and sequencing the tasks in the right order to achieve the Go Live date, while adhering to Quality and Compliance requirements
• Facilitate and manage mid-size workgroups, enabling a culture of collaboration, trust and disciplined accomplishment of tasks and target dates
• Make presentations to management on project updates, project cycle, and expected results
• Lead or contribute to the development of program or project scope statements, in consultation with applicable stakeholders
• Develop and maintain detailed project plans (including resource assignments, schedules, dependencies, etc.) and ensures projects are completed on time and in scope
• Monitor and report progress throughout the project life cycle, using appropriate project planning and scheduling tools (e.g., dashboards, metrics)

Requirements

• 2+ years of working within a healthcare/payor setting including experience with PCP and specialist capitation, Division of Financial Responsibility (DOFR) and familiarity with capitation payment cycles
• 2+ years of experience of gathering and documenting configuration requirements, creating and managing project task plans, and developing workflows
• 2+ years of experience managing/guiding projects to successful target delivery timeframes
• Solid knowledge of business end-to-end processes that impact provider capitation including contractual rate interpretation, capitation contract loading, and incentive language

Nice-to-haves

• Experience with OptumCare Strategic Platform (OCSP) or a UHC Secondary Platforms (CSP Community & State Facets or other Claim platform)
• Experience with managing or participating in system migrations or implementations
• Experience with capitation adjustments and capitation contract approval processes
• Experience with Medicaid or Medicare or Commercial or Exchange products and contracts
• Experience with cross-functional and line of business program management
• Proficiency with MS Word, Excel, PowerPoint, Visio, and SharePoint
• Proven strategic thinking ability to align project activities with organizational strategies contributing to overall business success
• Demonstrated ability to communicate ideas clearly and concisely in writing and verbally to individuals and groups
• Proven ability to demonstrate flexibility in dynamic project environments with the ability to adapt to changing project requirements and priorities
• Proven self-directed, reliable, acts with appropriate sense of urgency to the situation at hand

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution