Sign In
 [New User? Sign Up]
Mobile Version

Network Regulatory Program Consultant - Cypress, CA

UnitedHealth Group

Cypress, CA
Job Code:
Apply on the Company Site
  • Save Ad
  • Email Friend
  • Print
  • Research Salary

Job Details

732434 Network Regulatory Program Consultant Cypress CA

Network Regulatory Program Consultant - Cypress, CA (732434)

Position Description

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)


The Network Regulatory Program Consultant is responsible for the successful program design, compliance with network requirements, network assessment and selection, and program/product implementation. Network Regulatory Program Consultants may perform network analysis and strategy development and implementation; obtain data, verify validity of data, and analyze data as required, and analyze network availability and access. Other responsibilities may also include making recommendations regarding use, expansion, selection of networks for various products based on that analysis.

Primary Responsibilities:
  • Anticipate customer needs and proactively develop solutions to meet them
  • Serve as a key resource on complex and / or critical issues
  • Solve complex problems and develop innovative solutions
  • Perform complex conceptual analyses
  • Review work performed by others and provide recommendations for improvement
  • Forecast and plan resource requirements
  • Authorize deviations from standards
  • May lead functional or segment teams or projects
  • Provide explanations and information to others on the most complex issues
  • Motivate and inspire other team members

This role will be working closely with our West Region Network Adequacy team, our Legal and Regulatory Department and the local CA market team to support demonstrating network adequacy in the CA market. In addition this role will support product expansion and annual network adequacy reviews to our regulators.


Required Qualifications:

  • Undergraduate degree or equivalent work experience
  • 1+ years of claims knowledge
  • 2+ years of provider data maintenance, contracting, or contract loading
  • Intermediate level of proficiency and understanding of contract reimbursement methodologies
  • Excellent communication skills required including ability to communicate effectively with various levels of leadership
  • Proficiency in MS Office (Excel, PowerPoint, and Outlook).
Preferred Qualifications:
  • Project Management experience
  • Previous experience with Access
  • Understanding of capitated, delegated provider business model
  • Familiarity with regulatory as it relates to provider networks
  • Understanding of Commercial, Medicare, and Medi-cal

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near - obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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: Compliance, Network Compliance, Regulatory, Network Regulations, Network Programs, Cypress, CA, Long Beach, CA, Santa Ana, CA, Irvine, CA, Huntington Beach, CA, California

Job Details

  • Contest Number732434
  • Job TitleNetwork Regulatory Program Consultant - Cypress, CA
  • Job FamilyNetwork Management
  • Business SegmentUnitedHealthcare Networks

Job Location Information

  • Cypress, CA
    United States
    North America
  • Other LocationsIrvine, CA
    Long Beach, CA
    Santa Ana, CA
    Huntington Beach, CA

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • 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.

Powered ByLogo

Featured Jobs[ View All ]

Featured Employers [ View All ]