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Position in this function is responsible for the full range of provider relations and services interactions including provider recruitment, network development, provider education, provider credentialing and enrollment, processing provider applications and reapplications and contracting. Loads into various databases and ensures data quality. In addition, the manager develops ongoing relationships with providers and assists with the resolution of claims or contractual issues, as well as provider manual and newsletter development. The Manager of Provider Services is responsible for the development and management of the Fee for Service (FFS) Medi-Cal and the Treatment and Evaluation Resources Management (TERM) provider networks.

Hybrid role - in office 3 days per week

Primary Responsibilities:

• Sets team direction, resolves problems, and provides guidance to provider services staff
• Develops departmental plans and priorities to address business and operational needs
• Develops and implements departmental and individual staff metrics, provide data for operational decisions
• Develops and implements quality assurance processed to ensure Network demographics are accurate in various databases and directories
• Implements provider recruitment and contracting, and oversees the updating of data, fee schedules, coding, and billing as applicable
• Locating and contracting through single case agreements out of network providers for specific specialties or services as requested by the County
• Oversees Skilled Nursing Facilities contracting and updates fee schedules for these
• Attends and participates diverse stakeholder/customer meetings to highlight operations for the FFS Medi-Cal and TERM provider networks
• Oversight of Child and Family Well-Being (CFWB) Invoices for single case agreements
• Oversight of Council for Affordable Quality Healthcare (CAQH) and Credentialing Verification Organization (CVO) monthly invoices for all FFS, TERM and San Diego County Psychiatric Hospital (SDCPH) provider files
• Oversees credentialing, enrollment and contracting processes; update processes as needed to meet National Committee for Quality Assurance (NCQA) or County standards
• Oversees Primary Source Verification for SDCPH following Joint Commission on Accreditation of Healthcare Organization (JAHCO) or County Standards
• Reviews and provides feedback, solutions to State All Plan Letters, Mental Health & Substance Use Disorder Services (MHSUDS) / Behavioral Health (BH) Information Notices, Federal Network Notices or County highlighted Notices
• Collaborate with other site managers to ensure smooth end to end functioning of site wide processes and identify potential root cause of issues
• Work with other stakeholders to identify obstacles and barriers and methods for removing them
• Oversight of recruitment planning for FFS Medi-Cal and TERM Networks
• Implement provider solutions to improve provider satisfaction
• Respond to provider requests and direct them to correct internal or external resources
• Additional duties as necessary to successfully managed the provider networks and staff

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:

• Master's degree required; clinical licensure (LCSW, MFT, LPCC, Ph.D., PsyD., or MSN)
• 3+ years of experience in the behavioral health managed care environment
• Experience with provider contracting
• Proficiency in Microsoft applications and SharePoint
• Proven excellent verbal, written and interpersonal skills
• Able and willing to work in the office 3 days per week

Preferred Qualifications:

• Clinical experience with seriously mentally ill clients in the public sector
• Experience working with state/county regulatory bodies
• Management experience

California Residents Only: The salary range for California residents is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.