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Network Contracting Manager

3 months ago


St Louis, Missouri, United States Optum Full time
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care.

Network contracting manager will support the development of the provider network (physicians, hospitals, pharmacies, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management.

The developed network will produce an affordable and predictable product for customers and business partners.

If you are located in IL or MO, you will have the flexibility to work remotely* as you take on some tough challenges.

Conducts outreach to potential providers.
Supports development of the provider network (physicians, pharmacies, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for cost performance
Performs straightforward contract negotiation and pricing - evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls
Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties
Balance financial and operational impact of contracts to providers, members, and different customer groups when developing and/or negotiating contract terms
Support evaluation of market rates and provider performance (e.g., billing patterns; quality and effectiveness) in order to establish provider rates and negotiation strategies
Explain the organization's direction and strategy to internal partners and providers in order to justify methodologies, processes, policies, and procedures
facilities) to gather relevant information, recommend solutions, execute on deliverables as assigned and explain results/decision/activities
Monitor and/or oversee provider financial performance to identify opportunities to improve performance and/or provider relationship
Monitor and/or oversee network performance and industry trends to identify opportunities to refine, develop, and/or implement market strategies
Works with less structured, more complex issues
Solves moderately complex problems and/or conducts moderately complex analyses

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.

2+ years of experience with network contracting or provider relations in a managed care environment

Demonstrate understanding of and utilize applicable financial tools (e.g., HCE's RVU/Unit tool) and reports (e.g., internal financial models; Demonstrate understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changes.

provider networks; market intelligence; Proven abiity to utilize appropriate contract management systems (e.g., Contract Attachment Repository) to author and execute contracts and to access supplemental contractual documents
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.

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.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.