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Network Contracting Manager

3 months ago

Chicago, 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. Join us to start Caring. Connecting. Growing together.

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.

Primary Responsibilities:

  • 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; referral 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
  • Identify and gather information regarding provider issues in order to develop and/or implement strategy to resolve matter, keep manager informed of progress, or escalate issue to appropriate internal business partner
  • Represent department in external meetings (e.g., ancillary providers; physician groups; 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
  • Other duties as assigned.

Key Work Attributes:

  • Generally work is self-directed and not prescribed. Serves as a resource to others
  • Works with less structured, more complex issues
  • Ability to adapt quickly as an high growth less mature business contributes to a dynamic, fluid, high learning work environment
  • Assesses and interprets customer needs and requirements
  • Identifies solutions to non-standard requests and problems
  • Solves moderately complex problems and/or conducts moderately complex analyses
  • Works with minimal guidance; seeks guidance on only the most complex tasks
  • Coaches, provides feedback, and guides others. Acts as a resource for others

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:

  • 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., HPM; PPM; FAT; HCE's RVU/Unit tool) and reports (e.g., internal financial models; external reports) to develop rates
  • Demonstrate understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changes.
  • Demonstrate understanding of competitor landscape within the market (e.g., rates; market share; products; provider networks; market intelligence; GeoAccess)
  • Proven abiity to utilize appropriate contract management systems (e.g., Emptoris; PEGA; 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. 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: 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment