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Credentialing Network Program Specialist - Irvine CA

UnitedHealth Group

Irvine, CA
Job Code:
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Job Details

754101 Credentialing Network Program Specialist Irvine CA

Credentialing Network Program Specialist - Irvine CA (754101)

Position Description

There comes a point when you're ready to take off the training wheels and start guiding others. If that's where you are today, let's talk about where you can be tomorrow with our leading, global health care organization. UnitedHealth Group is driving ever higher levels of sophistication in how provider networks are composed and compensated. Everything is open to new ideas and innovation. Here's where you come in. Your expertise in provider networks can help us build in the next phase of evolution. In this role, you'll use your knowledge and analytical skills to help determine how clinical providers group up by specialty and service line. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 6 leader.



Primary Responsibilities:

  • Positions in this function are responsible for all activities associated with credentialing or re-credentialing providers in counties identified with high fraud, waste, & abuse

  • Process provider applications and re-applications including initial mailing, review, and loading into the database tracking system ensuring high quality standards are maintained.

  • Effective communication of findings with pharmacy and / or legal representation

  • Obtain documents from pharmacy & review to offset findings

  • Assist in any client audits


This is no easy task. There are a lot of details to manage, key projects to support, a heavy administrative role and reliance on your analysis to drive committee decisions.

Required Qualifications:

  • Undergraduate degree or equivalent work experience

  • 2+ years of experience with network data management in a managed care environment

  • 2+ years of experience in provider data analysis

  • 2+ years of experience with credentialing and / or auditing

  • 1+ years of experience working with reporting tools and generating effective reports

  • Ability to convey complex information to others and make it more easily understood


Preferred Qualifications:

  • Project management experience



Building diverse, high quality provider networks is creating greater access to health care and improving the lives of millions. Join us. Learn more about how you can start doing your life's best work.(sm)


UnitedHealth Group is working to create the health care system of tomorrow.


Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.


Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.


Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.




Diversity creates a healthier atmosphere: UnitedHealth Group 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.


UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Details

  • Contest Number754101
  • Job TitleCredentialing Network Program Specialist - Irvine CA
  • Job FamilyNetwork Management
  • Business SegmentOptumRx

Job Location Information

  • Irvine, CA
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt

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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