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Job Details

UnitedHealth Group

External Provider Relations Representative - TX (106197690)

Advertising and Public Relations




McAllen, Texas, United States

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

The External Provider Relations Representative is responsible for maintaining working relationships with the existing Provider Network. Provides training and education regarding policy and procedures and covered benefits. Provides ongoing support for any issues. May assist with Network Development as needed.

Primary Responsibilities:

  • Assists in the implementation of the Provider Relations Department processes, provider education programs and overall network functions
  • Works with the management team to develop and revise the Provider Manual. Assists in ensuring that the manual meets operational, regulatory, and accreditation requirements
  • Carries out the site review process (for credentialing and re-credentialing), provider manual documentation for education and training, referral and authorization procedures, and department activities
  • Serves as a mode of communication to provider offices
  • Assists in meeting organizational goals and objectives
  • Acts as the liaison between the provider groups and the plan
  • Carries out methods of communication to the providers for changes, revisions, issue resolution, and general notices/updates from the plan
  • Attends Provider Relations meetings to determine network access and availability, and meeting the requirements for ongoing membership needs
  • Assists with network publication, reports, updates, revision, analysis, and reporting to appropriate internal staff and the Dental Management Committee
  • Provides provider training and education manual and processes, documentation, reviews
  • Other plan required duties and responsibilities as deemed necessary and appropriate

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:

  • High School Diploma or GED
  • 2+ years of customer service experience
  • Proficiency in Microsoft Office (PowerPoint, Excel, Word)
  • Ability to deliver presentations (Provider training/education)
  • Ability to travel extensively in the future
  • Based in southern Texas, McAllen, Brownsville, Laredo, Edinburg
  • Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance

Preferred Qualifications:

  • Bachelor’s degree in any related field
  • Experience in Medicaid managed care
  • Knowledge of Dental terminology or Dental Experience
  • Bilingual or Trilingual preferred (English/Spanish or English/Spanish/French Creole)
  • Excellent oral and written communication skills
  • Effective analytical problem-solving skills
  • Ability to foster positive, productive working relationships
  • Ability to conduct self in an acceptable, professional manner and adhere to ethical standards and confidentiality requirements

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low- income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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.