UnitedHealth Group Network Contracting Manager - Overland Park, KS in Overland Park, Kansas
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
Network Contracting Manager is responsible for jobs related to provider network contract negotiation and pricing to support the development of geographically competitive, broad access, stable provider network that is both affordable and predictable. Adheres to policies, procedures and regulations to ensure compliance and patient safety. Participation in Compliance and other important training is a condition of employment.
Develops the provider network (physicians, pharmacies, ancillary groups & facilities, etc) yielding a geographically competitive, broad access, stable network that achieves objectives for cost performance
Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls
Manages and is accountable for team members and/or supervisors as needed
Establishes and maintains strong business relationships with 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
Evaluate market rates and provider performance (eg, 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 (eg, 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
Educate providers on the organization's processes, policies, and procedures in order to ensure provider compliance and ease of Administration
Monitor and/or oversee network performance and industry trends to identify opportunities to refine, develop, and/or implement market strategies
Other duties as assigned
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.
Bachelor’s Degree in related field - related education and experience may be substituted for one another on a year for year basis
2+ years of experience with network contracting in a managed care environment
Demonstrated 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
Utilize appropriate contract management systems (e.g., Emptoris; PEGA; Contract Attachment Repository) to author and execute contracts and to access supplemental contractual documents
Demonstrated understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changes
Demonstrated understanding of competitor landscape within the market (e.g., rates; market share; products; provider networks; market intelligence; GeoAccess)
Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with Optum . Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
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.