IPA Operations Manager - Inland Empire

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.  

The IPA Operations Manager will serve as the primary point of contact and central resource for the IPA provider network.  As an IPA Operations Manager, you will be responsible for providing exceptional service to our network of healthcare providers.  You will work closely with providers to educate them on IPA policies, manage key performance initiatives, coordinate operational processes, and address any issues or concerns.  In addition, this position will fulfill all administrative duties and independently drive marketing and business development efforts to strengthen our network in serving the growing healthcare needs of the market.

Primary Responsibilities:

• Develop and maintain strong relationships with network providers to ensure high-quality service delivery and promote IPA growth
• Network expansion focusing on new PCP/SPC recruitment for identified geographic areas
• Collaborate with providers to ensure understanding of IPA policies, procedures, and guidelines
• Assist providers with claim submission and payment processes, including understanding coding and billing guidelines
• Respond promptly to provider inquiries and concerns, escalating issues to appropriate parties as needed
• Ensure all provider-related data is accurate and up to date in IPA databases and systems
• Collaborate with internal teams to facilitate timely and effective resolution of provider issues
• Participate in training and education sessions to develop and maintain a deep understanding of healthcare industry trends, regulations, and compliance requirements
• Identify opportunities to improve IPA processes and procedures to better support our network of providers
• Submit / process Contract Request for PCP & Specialists including but not limited to amendment/transmittal
• Serves as liaison with Health plans related to member eligibility, member issues, and provider related inquiries
• Assist IPA with Specialty contracts discussions, negotiations and on boarding of new Specialty groups
• Coordinates, track and supports deployment of new PCP onboarding (systems, access, office readiness)
• Collaborate on updates, tracking and deployment of PCP variable comp dashboards, and Annual notices, renewals/Smart sheets updates, and follow up
• Monthly Specialties Cap Split report calculations
• Assist with annual tabulations of PCP and Specialty incentive programs results
• Distribution of PCP & Specialty CAP Report/Pre-Cap Summaries to providers
• Participate in IPA FISH/UM review and communicate updates accordingly
• Assist with coordination and tracking of IPA monthly network Cap leakage
• Serve as the primary point of contact and central resource for any Quality, Risk adjustment and growth-related initiatives, questions, or inquiries
• Adhoc duties related to provider and patient care

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:

• 2+ years of experience in a network management-related role, such as contracting or provider services
• 2+ years of provider relations or managed care experience
• 2+ years of sales or marketing experience within a matrix organization or experience in a metric/goal driven environment
• Provider recruitment and contracting experience
• Experience working with diverse patient populations
• Experience outreaching to prospective patients and providers
• Experience presenting materials to clients internal or external
• Experience working with a wide range of people including physicians, patients, office staff, hospital executives, and other health plan staff
• Willingness to travel regularly (locally within the Inland Empire) up to 75% of the time

California Residents Only: The salary range for this role is $88,000 to $173,200 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.

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 employers 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.