Healthcare Network Specialist

2 weeks ago


Pearl City, Hawaii, United States UnitedHealthcare Full time
About the Role

We are seeking a skilled professional to join our team as a Healthcare Network Specialist. In this role, you will play a critical part in developing and supporting provider networks, guiding unit cost management activities, and analyzing financial models.

Key Responsibilities
  • Manage unit cost budgets, target setting, performance reporting, and associated financial models.
  • Predict emerging customer needs and develop innovative solutions to meet them.
  • Help develop geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management.
  • Evaluate and negotiate contracts in compliance with company templates, reimbursement structure standards, and other key process controls.
  • Ensure that network composition includes an appropriate distribution of provider specialties.
Requirements
  • 3+ years of experience in a network management-related role, such as contracting or provider services.
  • 2+ years of experience in fee schedule development using actuarial models.
  • 2+ years of experience using financial models and analysis to negotiate rates with providers.
  • 2+ years of experience in performing network adequacy analysis.
  • In-depth knowledge of Medicare Resource Based Relative Value System (RBRVS).
  • Intermediate level of knowledge of claims processing systems and guidelines.
About UnitedHealthcare

At UnitedHealthcare, we're committed to simplifying the healthcare experience, creating healthier communities, and removing barriers to quality care. We believe everyone deserves the opportunity to live their healthiest life, and we're dedicated to making that a reality.

We're an equal employment opportunity/affirmative action employer and welcome applications from diverse candidates. We're a drug-free workplace and require candidates to pass a drug test before beginning employment.



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