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Network Contract Manager - Dallas, Ft. Worth, Tyler, & Longview, Texas at UnitedHealth Group

Network Contract Manager - Dallas, Ft. Worth, Tyler, & Longview, Texas

UnitedHealth Group Dallas, TX (Onsite) Full-Time

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)

The Network Contract Manager develops the provider network by establishing and maintaining a solid business relationships with Primary Care Physician, Specialty Physicians, or Ancillary providers and ensures the network composition includes an appropriate distribution of provider specialties.

Primary Responsibilities:

  • Develop/Negotiate/Support Terms of Agreement with providers
  • Balance financial and operational impact of contracts to providers, members, UHN, and different customer groups when developing and/or negotiating contract terms
  • Demonstrate understanding of contract policies to ensure compliance and consistent contracting across the enterprise
  • Demonstrate understanding of contract language and terms of the agreement to ensure that financial/operational impact and legal implications are aligned with business objectives
  • Demonstrate understanding of contractual financial and non-financial terms
  • Communicate proposed contractual terms with a provider and negotiate a mutually acceptable agreement
  • Seek information from relevant sources (e.g., COB data; publications; government agencies; providers; provider trade associations) to understand market intelligence information
  • Evaluate current contract performance to identify potential remediation opportunities and/or cost savings
  • Demonstrate understanding of competitor landscape within the market (e.g., rates; market share; products; provider networks; market intelligence; GeoAccess)
  • Demonstrate understanding of provider termination process
  • Manage Provider Relationships
  • Explain the organization's direction and strategy to internal partners and providers to justify methodologies, processes, policies, and procedures
  • Demonstrate benefits of applicable reimbursement methodology to internal partners and providers
  • Identify and gather information regarding provider issues to develop and/or implement a strategy to resolve the matter, keep the manager informed of progress, or escalate the issue to the appropriate internal business partner
  • Represent department in external meetings (e.g. physician groups; facilities) to gather relevant information, recommend solutions, execute on deliverables as assigned, and explain results/decision/activities
  • Report back information from provider meetings to the applicable stakeholder (e.g., manager; business partner) to determine appropriate action)
  • Conduct high-level meetings with Executive Staff and Providers  Virtual or In-person
  • Coach, provide feedback and guide others internal and external
  • Generally work is self-directed and not prescribed
  • Attend bi-monthly provider dinners and/or semi-annual provider summits

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:

  • Undergrad degree or equivalent work experience
  • 3+ years of experience in a network management-related role, provider relations, or account management- such as contracting 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
  • Intermediate level of knowledge of claims processing systems and guidelines
  • Intermediate knowledge of Microsoft Word and Excel (pivot tables, formulas etc.)
  • Ability to travel up to 75% regionally

Preferred Qualifications:

  • Bachelor’s degree
  • Value-Based Care experience with the understanding of delegation of risk and managed care
  • In-depth knowledge of Medicare Resource-Based Relative Value System (RBRVS)
  • Experience managing value-based managed care relationships and accountable care organizations 
  • Experience in health plan contracting with shared saving agreements
  • Excellent presentation skills

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

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.

Recommended Skills

  • Account Management
  • Actuarial Science
  • Business Planning
  • Claim Processing
  • Coaching And Mentoring
  • Contract Negotiation
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