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Associate Director Provider Relations - MA LTSS (Boston)

UnitedHealth Group

Boston, MA
Job Code:
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Job Details

Associate Director Provider Relations - MA LTSS (Boston)(Job Number:702868)

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 and help people live healthier lives while doing your life's best work.(sm)
The Associate Director, Provider Relations is a lead position is accountable for employees that work in Provider Relations and Quality Improvement area.
Primary Responsibilities:
  • Establish leadership, structure, policies and procedures, monitoring and oversight processes to ensure overall outcomes, optimal provider relation experiences
  • Provider Relations and quality compliance oversight
  • Oversight of Provider Relations Representatives Specialists
  • Actively participate in quarterly LTSS Provider Quality Forums and monthly LTSS Provider Review Committee to identify improvement opportunities promptly and providing input  for remedial actions as necessary for potential quality of care concerns
  • Coordinate monthly LTSS Provider Review Committee meetings to review provider quality of care issues and recommend actions for enrollment, credentialing and revalidation findings
  • Summarize committee findings in a monthly LTSS Provider Review Committee report and an annual Provider Review Summary Report
  • Establish quarterly LTSS Provider Quality Forums aimed at informing and training providers on targeted quality measures, using provider-specific score cards
  • Training of internal staff and external LTSS Providers
  • Review of Provider Scorecard  and develop annual Provider Quality Performance Plan
  • Review of annual Provider and Member survey trending results with actionable improvement plan
  • Review monthly quality reporting - Call Center, turnaround times, enrollment activities, credentialing/revalidation activities and coordinates reporting to EOHHS
  • Work with Quality Improvement Committee to develop and implement appropriate corrective action plans
  • Assist with LTSS provider communications
  • Use risk management and patient safety data to identify and implement quality improvement, for example, prompt identification and handling of member abuse, neglect, and/or exploitation
  • Identify outlier providers who require technical assistance and use rapid cycle improvement technologies (Plan-Do-Study-Act) to improve their administrative and / or care delivery practices
  • Support continuous improvement of annual employee engagement scores
  • Provide coverage for RN Utilization Management Lead and Appeals Coordinator

Job Clinical Utilization Managemen
Primary Location US-MA-Boston
Other Location 
Organization Government Solutions Sr Mgmt
Schedule Full-time
Number of Openings 1
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UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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