Leads strategic provider network programs, performance analysis, client-specific mandates, benefit expansions, quality initiatives, reporting, audits, and network transformation projects. Collaborates with contracting, provider relations, clinical, regulatory, operations, and market leadership teams. Presents to executives and clients, monitors performance guarantees and emerging provider trends, drives corrective actions, manages provider communications, and mentors network program staff. The role requires provider relations experience, Medicare and Medicaid regulatory knowledge, claims-processing familiarity, strong presentation skills, and travel up to 50%.
Requisition Number: 2385095
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Tactical Responsibilities:
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Preferred Qualifications:
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 - $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Lead the development, implementation, and oversight of strategic network initiatives and programs that support customer business objectives
- Analyze provider network performance through analysis of access, adequacy, utilization, quality, financial performance, and operational metrics and identify opportunities for process improvement, efficiency, and provider experience enhancement
- Collaborate with provider contracting, provider relations, operations, regulatory, clinical, and market leadership teams to execute customer specific network strategies
- Lead implementation on client-specific network mandates, ensuring operational readiness and compliance. Includes working directly with clients
- Direct cross-functional projects, including benefit expansions, value-based care initiatives, reimbursement programs, and network transformation efforts
- Analyze market trends, network performance data, and provider feedback to inform leadership decisions specific to customer performance
- Support executive leadership through reporting, program governance, issue resolution, and communication of key network initiatives
- Provide leadership, coaching, and mentorship to network program staff and project teams when applicable
Tactical Responsibilities:
- West Region Direct Payer Network Point of Contact
- Project Manage Provider Bulletins that impact provider networks
- Ensure client specific Network Reporting set up and maintenance
- Support benefit expansion initiatives
- Support network quality improvement initiatives
- Monitor performance guarantees
- Monitor emerging trends coming from provider-facing teams. Implement corrective action plans
- Regulatory and Customer audit - provider network deliverables
- Client QBR participant
- Oversee trade org relationships
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- 4+ years of provider relations experience
- 3+ years of experience with Medicare and Medicaid regulations
- Comfortable with Executive Level Presentations
- Demonstrated experience in customer relationship management
- Ability to call on Providers
- Intermediate level of knowledge of claims processing
- Demonstrated proficiency in MS Word, PowerPoint, Excel, and Access
- Demonstrated exceptional presentation, written and verbal communication skills
- Dedicated, distraction-free workspace and access to high speed internet in home
- Ability to travel up to 50%
- Driver's license and access to reliable transportation
Preferred Qualifications:
- 5+ years of supervisory level experience in a network management-related role handling complex network providers with accountability for business results
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 - $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Similar Jobs at Optum
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
Reviews and adjudicates medical appeals and grievances for health plan products, applying benefit interpretations and clinical criteria. Responds to insurance and CMS regulatory inquiries, communicates decision rationales and network-quality issues, and contributes to committees, process improvement, training, projects, and task forces. Requires strong clinical judgment, managed care knowledge, communication, presentation, data analysis, and project management skills.
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
Build and deploy AI-powered, LLM-based solutions in client environments. Implement integrations between models, APIs, and healthcare systems, write production-ready code, support testing and deployments, assist data preparation and prompt configuration, troubleshoot issues, and collaborate with cross-functional teams and clients to deliver scalable, secure solutions and enable knowledge transfer.
Top Skills:
APIsAWSAzureClaudeCodexData PipelinesDistributed SystemsGCPJavaLlmsPrompt EngineeringPythonSQL
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
Manage provider contracting, negotiate rates using financial and actuarial models, build geographically competitive networks, perform network adequacy analysis, host stakeholder meetings, educate accounts on compliance, and collaborate cross-functionally to drive network growth and solutions.
Top Skills:
Actuarial ModelsClaims Processing SystemsRbrvs
What you need to know about the San Francisco Tech Scene
San Francisco and the surrounding Bay Area attracts more startup funding than any other region in the world. Home to Stanford University and UC Berkeley, leading VC firms and several of the world’s most valuable companies, the Bay Area is the place to go for anyone looking to make it big in the tech industry. That said, San Francisco has a lot to offer beyond technology thanks to a thriving art and music scene, excellent food and a short drive to several of the country’s most beautiful recreational areas.
Key Facts About San Francisco Tech
- Number of Tech Workers: 365,500; 13.9% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: Google, Apple, Salesforce, Meta
- Key Industries: Artificial intelligence, cloud computing, fintech, consumer technology, software
- Funding Landscape: $50.5 billion in venture capital funding in 2024 (Pitchbook)
- Notable Investors: Sequoia Capital, Andreessen Horowitz, Bessemer Venture Partners, Greylock Partners, Khosla Ventures, Kleiner Perkins
- Research Centers and Universities: Stanford University; University of California, Berkeley; University of San Francisco; Santa Clara University; Ames Research Center; Center for AI Safety; California Institute for Regenerative Medicine

