Director Network Development

1 week ago

Chattanooga, Tennessee, United States UnitedHealth Group Full time
UnitedHealth Group

Director Network Development - Remote

Chattanooga ,

Tennessee

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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. Join us to start

Caring. Connecting. Growing together.

The health care system needs to evolve even further than it has and it has to do so at a lightning fast pace.

New models of care and networks of providers are emerging now to better serve patients and communities. And at UnitedHealth Group, we are playing a lead role. Here's where you come in.

As a manager within our network contracting team, you'll guide the development and support of provider networks as well as unit cost management activities through financial and network pricing modeling, analysis and reporting.

In return, you'll discover the impact you want and the resources, backing and opportunities that you'd expect from a Fortune 5 leader.

Currently, Optum Health employs physicians inside its medical group assets and also runs a large risk-bearing entity (RBE) with global risk contracts covering over 250,000 dual-eligible MA members across several states.

The leadership is focused on aggressively expanding (1) owned-clinic assets, (2) contracted physician network, and (3) the membership assigned to the RBE in the region.

The vision is to build a regional, integrated care delivery system that can accept pre-payment (capitation) and full accountability for patient members across multiple payers and multiple segments (e.g., MA and commercial).

To do this, Mid Atlantic will pursue strategic growth and development opportunities across the full ambulatory care delivery spectrum, including physician offices, ambulatory surgery centers, home care, behavioral health, post-acute care and digital care assets.

The region also will focus on membership growth by partnering upstream with leading MA and commercial plans through value-based contracts.

Mid Atlantic is committed to building and a market-leading value proposition of high quality, high value care delivery for all patient members.

The primary focus of the Director of Network Development is to drive the RBE's provider network development and managed care contracting execution across the Mid-Atlantic region.

The role will require both direct contracting and relationship building of key entities as well as the day to day management of the OH Mid-Atlantic contracting team.

This directly contracted network is the cornerstone for RBE growth across the region for all current and future capitation contracts.

The Director will play both a management and "hands-on" role in relationship development and contract execution and requires strategic and critical thinking, negotiating skills, and the ability to get things done in the business.

In this capacity, the role will collaborate closely with cross functional team leads in the region including Market Operations, Data Analytics, IT/Analytics, Finance, and Executive.

The position offers significant professional growth opportunity and the opportunity to participate in a highly innovative network build that integrates finance and healthcare delivery under total cost of care contracts throughout the region.

If you are located in Mid-Atlantic, you will have the flexibility to work remotely* as you take on some tough challenges.


Primary Responsibilities:
Strategy development for direct network contracting and quality incentive program policy across the Mid-Atlantic region
Creating relationships, developing proposals, and driving contract execution across the region
Maintaining key hospital, ancillary providers, independent practice associations (IPA's), and large physician groups relationships
Leading and managing day to day contracting team towards growth goals and corporate deliverables
Ensuring cost effective and financially stable provider network
Analyzing past payment and utilization data, developing rate proposals and responding to provider rate proposals
Reviewing and negotiating contract language provisions with high-level administrators
Negotiating effective and competitive contractual relationships in accordance with OH strategies
Coordinating contract implementation and education to enhance quality and cost effectiveness
Supervising and assisting in pre and post contract implementation audits to ensure provisions meet the intent of the contract
Coordinating issue resolution and complex trouble shooting for providers with Network operations team. Analyzing macro and micro issues related to medical costs

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 fee-for-service/ACO/value-based care contracting or managed care experience at an integrated delivery system, population health services company or health insurance plan
Experience managing a large team of direct and indirect reports
Experience in developing regional contracting strategy and formulating into actionable execution plan
Experience in external facing contract negotiation & Medicare Advantage network build within all settings of care (Health system, multi-specialty providers, and all ancillary care settings)
Experience in understanding of Medical Loss Ratio (MLR) and capitated downstream arrangements
Advanced knowledge of Microsoft PowerPoint; proficiency in Microsoft Excel and Word
Understanding of healthcare value-based concepts, Medicare payment methodology, and fee for service reimbursement methodologies across various specialties and facilities
Understanding and experience with regional and national reasonable Medicare Advantage rates for all settings of care
Basic understanding of Healthcare financial pro formas and P&L development across network of providers
Solid understanding of CMS Medicare Advantage provider network rules and regulations (i.e., Adequacy requirements and equal access)
Models concepts of continual learning and willingness to be a thought partner with other members of the Population Health team
Proven exceptional written and oral presentation skills with the ability to engage external audiences and build credibility and trust
Proven excellent organization skills with an ability to multitask across projects in a variety of subject matter areas and manage up to ensure milestones are met
Proven collaborative style with ability to successfully activate team members and senior leadership to support IPA participant operational execution
Proven to be self-starter with solid analytical, critical thinking and problem solving skills, able to work with minimal supervision
Proven ability to develop and present contextually rich and visually compelling presentations to clearly communicate complex concepts

CONTACT RELATIONSHIPS:
Frequent contact with employees, physicians, patients and outside agencies.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this job.


They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

*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.

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.


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.

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