UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)
As a Senior Network Contract Manager - Hospital-Based Physician Groups, you will develop and maintain the national provider network (physicians, hospitals, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners. Senior Network Contract Managers evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Responsibilities also include establishing and maintaining strong business relationships with Hospital, Physician, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Manage unit cost budgets, target setting, performance reporting and associated financial models with hospital-based physician groups and other provider types
- Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance, trend management and appropriate distribution of provider specialties
- Incorporate impact of regulatory rules/out of network programs in hospital based overall strategy development
- Assess and interpret customer needs and requirements
- Identify solutions to non-standard requests and problems
- Work with minimal guidance; seek guidance on only complex tasks
- Act as a resource for others with less experience
- Evaluate and negotiate contracts in compliance with company templates, reimbursement structure standards and other key process controls, establishment of relationships with large ancillary and physician groups, PHO's, IPA's etc.
- Utilize knowledge using a contracting database, acuity for financial models, and experience with performance-based contracting and ACO arrangements
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.
- Undergraduate degree or equivalent experience
- 5+ years of experience in a network management-related role, such as contracting or provider services
- 3+ years of experience with facility, ancillary and/or physician contracting, such as (i.e., large medical groups, hospitals, FQHC/RHC’s, Ancillary, Urgent Care, PHO's, IPA's, other)
- 2+ years of experience with provider contracting including development of product pricing and utilizing financial modeling in making rate decisions
- Demonstrated knowledge of systems commonly used within network management such as CLM, MSPS, FIRST, IMPACT, Emptoris, NDB, etc.
- Proficiency with MS Office Suite
- 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
- 3+ years of experience in fee schedule development using actuarial models
- 3+ years of experience utilizing financial models and analysis in negotiating rates with providers
- Experience with Hospital-based physician groups (i.e., Hospitalist, Emergency, Anesthesia, Pathology)
- Knowledge of Medicare reimbursement methodologies, i.e., Resource Based Relative Value System (RBRVS)
- Intermediate level of knowledge of claims processing systems and guidelines
- Excellent verbal and written communication skills
- Solid interpersonal skills, establishing rapport and working well with others
- Solid customer service skills
- Ability to multi-task
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 UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)
Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $82,100 to $146,900. The salary range for Connecticut / Nevada residents is $90,500 to $161,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.