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Director of Provider Network and Credentialing - Boston, MA

UnitedHealth Group

Boston, MA
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Job Details

743655 Director of Provider Network and Credentialing Boston MA

Director of Provider Network and Credentialing - Boston, MA (743655)

Position Description

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)


MA LTSS (Long Term Services and Support) provide services such as home health care services, adult day health and durable medical equipment for individuals with physical, intellectual or developmental disabilities, or who need support with activities of daily living. We are serving as the state’s Third Party Administrator (TPA), providing clinical, administrative, operations and systems support for a program with $3.5 billion in annual spend.  Our program services include:

  • Credential, enroll and train providers
  • Perform prior authorization and utilization management as directed by MassHealth
  • Conduct analyses on utilization and quality patterns
  • Support providers’ claim inquiries
  • Strengthen program integrity

The Director of Provider Network and Credentialing is a leadership position accountable for employees that work in Provider Relations area to include Enrollment & Revalidation and Provider Call Center.  In addition, the position is actively client facing and engaged in working cross - functionally to develop initiatives and programs to improve the ability to more efficiently service those who require LTSS services.


Primary Responsibilities:

  • Establish leadership, structure, policies and procedures, monitoring and oversight processes to ensure overall outcomes and optimal provider experiences
  • Oversight of Provider Relations Manager and team, and associated enrollment & re - credentialing team members
  • Actively participate in client meetings to identify improvement opportunities promptly and continue to enhance operations and provider experience
  • Develop training materials for internal staff and the provider community
  • Oversee onsite LTSS Provider visits made by Enrollment & Revalidation team members
  • Review Provider Scorecard and develop annual Provider Quality Performance Plan
  • Review annual Provider and Member survey results and develop actionable improvement plan
  • Review and coordinate monthly quality reporting - Call Center, turnaround times, enrollment activities, credentialing / revalidation activities 
  • Work with Quality Improvement Committee to develop and implement appropriate corrective action plans
  • 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


Required Qualifications:

  • Bachelor’s Degree  
  • 5 years management experience
  • Demonstrated leadership capabilities, including driving team performance and building new programs
  • Ability to effectively manage office based and remote staff
  • Strong data analytical skills with the ability to leverage best practices
  • Ability to build and maintain relationships
  • Experience working with providers servicing the Medicaid or LTSS population
  • Excellent communication skills - verbal and written
  • Ability to present complex data clearly and concisely to external clients
  • Highly driven and ability to flexible and adaptable

Preferred Qualifications:

  • Master’s degree
  • Knowledge in Salesforce or other CRM system
  • 5 years’ experience in provider enrollment, credentialing and re - credentialing activities
  • 5 years’ claims servicing experience
  • 5 years’ experience with process / quality improvement activities

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)



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 Keywords: provider relations, network, credentialing, leadership, oversight, operations, scorecard, CRM, claims, Boston, MA, Massachusetts


Job Details

  • Contest Number743655
  • Job TitleDirector of Provider Network and Credentialing - Boston, MA
  • Job FamilyNetwork Management
  • Business SegmentOptum Government Solutions

Job Location Information

  • Boston, MA
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelDirector
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusExempt

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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