Manages provider relations and network operations across healthcare markets. Supports provider performance, claims issue resolution, network initiatives, escalation processes, and operational priorities. Analyzes claims-based performance data and provider feedback to develop recommendations and action plans. Partners with clinical operations, data management, product teams, and leadership to improve network performance, stakeholder satisfaction, and provider outcomes. Requires extensive managed care and provider network experience, Medicare and Medicaid knowledge, and travel up to 55%.
Requisition Number: 2388235
Optum Home & Community Care, part of the Optum family of businesses, is creating something new in healthcare. By bringing together industry-leading solutions, advanced technology and compassionate teams, we are building a more connected experience that helps address an individual's physical, mental and social needs. As a team member of our Optum Care Transitions team, you'll help patients navigate the healthcare system, access the support and services they need, and receive the right care at the right time. This meaningful work is helping improve health outcomes, expand access to care and create a more seamless health journey for the people we serve. Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.
The Manager, Provider Relations, plays a key role in supporting the Director, Provider Relations and contributes to a team that spans across markets, lines of business and clients. This position is an integral part of developing and executing the Market Operations strategy and performance of the provider outcomes. This is a collaborative role requiring critical thinking skills, independence, leadership, a strategic mindset, and attention to detail.
Primary 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 Qualification:
Soft Skills:
Work Conditions and Physical Requirements:
*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 $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.
UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Optum Home & Community Care, part of the Optum family of businesses, is creating something new in healthcare. By bringing together industry-leading solutions, advanced technology and compassionate teams, we are building a more connected experience that helps address an individual's physical, mental and social needs. As a team member of our Optum Care Transitions team, you'll help patients navigate the healthcare system, access the support and services they need, and receive the right care at the right time. This meaningful work is helping improve health outcomes, expand access to care and create a more seamless health journey for the people we serve. Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.
The Manager, Provider Relations, plays a key role in supporting the Director, Provider Relations and contributes to a team that spans across markets, lines of business and clients. This position is an integral part of developing and executing the Market Operations strategy and performance of the provider outcomes. This is a collaborative role requiring critical thinking skills, independence, leadership, a strategic mindset, and attention to detail.
Primary Responsibilities:
- Collaborate with Market and Clinical Operations teams to assist in service and product revenue growth and enhance stakeholder satisfaction
- Provide support to Executive Directors and the Director of Clinical Operations on network initiatives and operational priorities
- Work alongside Data Management teams to help resolve claims issues and contribute to provider performance tool improvements for multiple levels of care
- Assist in companywide initiatives by supporting efforts to market the enterprise and advance Provider Operations
- Partner with Product Teams to ensure new developments align with provider expectations and operational needs
- Compile and summarize claims-based performance data to support change management efforts at acute and PAC levels, helping create actionable recommendations that drive network performance and meet internal KPI goals
- Gather and analyze provider feedback to assist in developing action plans that improve network performance
- Support execution of strategic initiatives within the provider network by coordinating tasks and monitoring progress
- Assist in evaluating the impact of regional and national providers on market performance and provide insights to leadership
- Prepare and deliver supporting materials for presentations on provider performance tools to various audiences
- Manage provider escalation resolution processes across the market, ensuring consistent reporting and practices to reduce provider abrasion
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:
- 5+ years of health care/managed care experience
- 3+ years of provider relations and/or provider network experience
- 1+ years of experience with Medicare and Medicaid regulations
- Intermediate level of proficiency in claims processing and issue resolution
- Proficiency with MS Word, Excel, PowerPoint and Access
- Willing or ability to travel up to 55%
- Driver's license and access to reliable transportation
Preferred Qualification:
- Skilled Nursing provider experience
Soft Skills:
- Detail-oriented with the ability to independently plan, organize and prioritize work
- Ability to complete initiatives with minimal supervision
- Ability to build and foster relationships inside and outside the organization including C-suite level decision makers and operators
- Ability to influence and educate others
- A willingness to work toward team objectives
- Self-starter with effective communication skills
- Excellent presentation skills with high Emotional Intelligence
- Comfortable multi-tasking and operating in a matrixed organization
Work Conditions and Physical Requirements:
- Ability to establish a home office workspace
- Ability to manipulate laptop computer (or similar hardware) between office and site settings
- Ability to view screen and enter data into a laptop computer (or similar hardware) within a standard period of time
- Ability to communicate with clients and team members including use of cellular phone or comparable communication device
- Ability to remain stationary for extended time periods (1 - 2 hours)
- Ability to mobilize to and within sites within an assigned local or regional market/area, including car transport, up to 55% of the time
*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 $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.
UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are 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
Leads acute revenue cycle operations teams supporting multiple hospitals and clients. Oversees accounts receivable follow-up, payer strategy, denial prevention, billing, collections, escalations, and complex reimbursement resolution. Analyzes KPIs and revenue cycle reports to identify root causes, improve claims accuracy, reduce denials, accelerate cash, and enhance payer performance. Manages client relationships, compliance, staff development, hiring, and performance across a decentralized workforce.
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
Leads multi-state Medicare Advantage quality strategy to achieve 4+ Star performance. Uses HEDIS, CAHPS, HOS, and operational data to identify improvement opportunities, coordinate year-round quality initiatives, guide provider and market teams, and improve HouseCalls completion, measure closure, and clinical quality outcomes. Partners with national, regional, local, Optum, network, and executive stakeholders across a highly matrixed organization.
Top Skills:
CahpsCms Star RatingsHedisHos
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
Provides physician support for payer clinical operations by conducting coverage and medical necessity reviews, interpreting benefits and policies, documenting determinations, communicating with providers, participating in clinical rounds, and supporting cost-effective, quality care. The role requires a vascular surgery-trained physician to oversee utilization management and benefit determinations remotely for West Coast operations.
Top Skills:
ExcelMicrosoft OutlookMicrosoft Word
What you need to know about the Boston Tech Scene
Boston is a powerhouse for technology innovation thanks to world-class research universities like MIT and Harvard and a robust pipeline of venture capital investment. Host to the first telephone call and one of the first general-purpose computers ever put into use, Boston is now a hub for biotechnology, robotics and artificial intelligence — though it’s also home to several B2B software giants. So it’s no surprise that the city consistently ranks among the greatest startup ecosystems in the world.
Key Facts About Boston Tech
- Number of Tech Workers: 269,000; 9.4% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: Thermo Fisher Scientific, Toast, Klaviyo, HubSpot, DraftKings
- Key Industries: Artificial intelligence, biotechnology, robotics, software, aerospace
- Funding Landscape: $15.7 billion in venture capital funding in 2024 (Pitchbook)
- Notable Investors: Summit Partners, Volition Capital, Bain Capital Ventures, MassVentures, Highland Capital Partners
- Research Centers and Universities: MIT, Harvard University, Boston College, Tufts University, Boston University, Northeastern University, Smithsonian Astrophysical Observatory, National Bureau of Economic Research, Broad Institute, Lowell Center for Space Science & Technology, National Emerging Infectious Diseases Laboratories

