[Hiring] Senior Network Contract Manager @UnitedHealth Group

Role Description

In support of Optum’s mission, vision, and strategic goals, this position is responsible for building and maintaining a high-quality, high-performing specialty contract network. Reporting to the Vice President of Contracting and Payer Strategy, the Specialty Network Contract Manager creates, evaluates, and maintains Optum Care’s provider network (specialist physicians, pharmacies, ancillary, facilities, primary care physicians etc.). Success looks like a competitive, stable network that demonstrates the Quadruple Aim and Network Adequacy.

You are the first step in the evaluation and negotiation of proposed provider contracts in compliance with federal and state laws, company contract templates, provider strategy, and other key process controls. Ensures contracting tactics foster efficient and effective implementation through delegated and contracting providers. Establishes and maintains strong and trusted business relationships with provider network.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Works within department strategic vision, objectives, and policies and procedures. Participates in building objectives each year.
• Regularly meet with cross-functional team to assist in creating, evaluating and adjusting strategy for assigned provider groups to meet overall performance goals.
• Establish and maintain effective business relationships with potential and existing network providers on behalf of the organization.
• Participate in various department, leadership, or cross-functional meetings including Medical Directors, finance, operational team, and clinical staff.
• Recruit/contract specialist providers to build the networks in alignment with the overall growth strategy.
• Negotiate new contracts to ensure maximum revenue, operational efficiency and compliance.
• Play key role in the creation of local network and execution of network structure, assuring network adequacy and a high-performing specialist contracted network.
• Work with operational leaders to ensure effective operational implementation and adherence of payment and authorization practices is handed off appropriately.
• Ensure specialist providers have in-depth understanding of Optum Care model to navigate AR process, prior auth process, as well as meet quality goals, manage utilization / cost performance, contract performance.
• Maintain open and trusting communication with specialist providers and direct them to appropriate network managers to resolve issues.
• Collaborate, communicate, and manage specialist provider relationships including but not limited to complete Practitioner Data Forms, Provider Change Forms, membership attribution, Credentialing status, provider directories, system access, and other operational questions as needed.
• Request detailed analysis of various performance and trending data to identify opportunities to improve network construction and appropriately tier providers.
• Assess and interpret customer needs and requirements.
• Identify solutions to non-standard requests and problems.
• Work with minimal guidance; seek guidance on most complex tasks.
• Translate concepts into practice.
• Coach, provide feedback, and guide others.
• Proven contract negotiation skills.
• Ability to engage directly with senior-level management, providers.
• Demonstrate benefits of applicable reimbursement methodology to internal partners and providers.
• Solid influencing skills, track record of successful client relationship development.
• Exceptional interpersonal skills with ability to effectively interface and influence both internally and externally.
• Prioritize and organize own work to meet deadlines.
• Seek information from relevant sources to understand market intelligence information.
• Ability to work in a matrixed management environment.
• Solid verbal and written communications skills.
• Demonstrated comfort with data analysis and report review.
• Demonstrated experience with making presentations to both small and large groups.
• Ability to travel (post-COVID) up to 25% in Colorado geography.
• At least an intermediate proficiency with MS Suite (including Word, PowerPoint, Excel and Teams).
• Working level of knowledge of Medicare reimbursement methodologies.
• Interact and consult with manager and Network Pricing team to evaluate different financial arrangements.

Qualifications

• 3+ years of experience in a healthcare network management-related role, such as contracting or provider services.
• 3+ years of experience in fee schedule development using actuarial models.
• 3+ years of experience using financial models and analysis to negotiate rates with providers.
• 3+ years of experience in performing network adequacy analysis.
• 2+ years working with a managed care organization or health insurer; or as a consultant in a network/contract management role.
• In-depth knowledge of Medicare Resource Based Relative Value System (RBRVS).
• Intermediate level of knowledge of claims processing systems and guidelines.

Preferred Qualifications

• Undergraduate Degree or equivalent work experience.
• 2+ years of project management or project lead experience.
• Expertise in physician / facility / ancillary contract reimbursement methodologies.
• Expertise negotiating physician / facility / ancillary contracts.
• Established knowledge of local provider community.
• Assist in creating business strategies through excellent analytical and problem-solving skills.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected.