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Provider and Member Relations Director - Sacramento or Rancho Cordova, CA

UnitedHealth Group

Sacramento, CA
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746251 Provider and Member Relations Director Sacramento or Rancho Cordova CA

Provider and Member Relations Director - Sacramento or Rancho Cordova, CA (746251)

Position Description

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)


This is a Medicaid Leadership opportunity in California with a proposal to support large scale projects aligned to the effective and efficient delivery of services centered on payment of fee-for-service claims, provider and member relations, drug rebate, pharmacy operations support as well as other related services necessary to support the health care delivery. Candidates must be comfortable pursuing a permanent role that is contingent on future award status with client.


Primary Responsibilities:

  • Principal manager over the Provider and Member Relations Services operation. Positions in this function are accountable for the full range of provider relations and service interactions, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training & development of external provider education programs
  • Designs and implements programs to build and nurture positive relationships between the health plan, providers (medical, behavioral, dental, pharmacy, physicians, other individual providers, clinics, groups and hospitals) and practice managers
  • Directs and implements strategies relating to the development and management of a provider network. Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs
  • Involved in identifying and remediating operational short-falls and researching and remediating claims
  • Managing provider networks that support client base. This includes hospital, physician, dental, and pharmaceutical networks. Examples include provider relations activities, analyzing provider performance, creating provider reimbursement arrangements, and credentialing activities

Required Qualifications:

  • Bachelor’s degree and 4 years of management experience (additional relevant management experience may substitute for the degree on a year-for-year basis), including, but not limited to, administrative or program manager experience with substantial participation in the formulation, operation, and/or evaluation of Program policies
  • 2 years of MMIS or government or private sector healthcare payer experience
  • Provider and member relations management experience
  • Excellent verbal, written and presentation communications skills

Preferred Qualifications:

  • Experience with provider training/education
  • Claims knowledge 

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 and Member Relations Director, Sacramento, Rancho Cordova, CA, California

Job Details

  • Contest Number746251
  • Job TitleProvider and Member Relations Director - Sacramento or Rancho Cordova, CA
  • Job FamilyBusiness Operations
  • Business SegmentOptumInsight

Job Location Information

  • Sacramento, CA
    United States
    North America
  • Other LocationsRANCHO CORDOVA, CA

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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