Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm) The Network Contract Manager develops the provider network (physicians, hospitals, pharmacies, 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. 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, Pharmacy, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties. Primary Responsibilities:Assess and interpret customer needs and requirements Identify solutions to non-standard requests and problems Solve moderately complex problems and/or conduct moderately complex analyses Work with minimal guidance; seek guidance on only the most complex tasks Translate concepts into practice Provide explanations and information to others on difficult issues Coach, provide feedback, and guide others Act as a resource for others with less experienceIn addition, the Manager of Provider/Network Contracting acts in the role of contracting resource for our internal Department Managers as well as our Executive Directors and Provider Service Representatives. All resources on the team are fully utilized in their current positions therefore there is no position on the team that we can consolidate/absorb this position into. Other impacts include, driving of vital signs, risk of on time and quality delivery of amendments/agreements, turnaround times impact Transactional Services and Medical Management causing delays or incorrect claims payments, claims sent to incorrect addresses and provider information correctly appearing in our referral system. In addition to the delayed turnaround, the potential of impact to our NPS scores due to Provider dissatisfaction due to delay in changes of their Agreements. Additional responsibilities/functions of the Manager of Provider/Network Contracting: Attend meetings and Joint Operation Meetings with our Provider/Vendors Oversight of maintenance of original contract documents and departmental workflows Reviews contracts for accuracy and proposes revisions as needed Oversight of special projects 3-5 years equivalent experience in a healthcare related field Management experience of contracting processes from prep, negotiation & implementation and ability to understand contract structure (ie: risk, financial impact) Excel, Power Point, Work, Outlook General understanding of the healthcare industry and/or local physicians market Skill in organizing, prioritizing goals and responsibilities
Required Qualifications:3+ years' experience serving in a network management-related role, such as contracting or provider services In-depth knowledge of Medicare reimbursement methodologies, i.e. Resource Based Relative Value System (RBRVS) 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 3+ years of experience in performing network adequacy analysis Proficiency with Excel, Power Point, Word, Outlook 3+ years equivalent experience in a healthcare related field Experience negotiating rates, terms and manage hospital, ancillary and other network contracts Provide support and direction to PrimeCare Reps on PCP/Specialist contracting best practices Facilitate Letters of Agreements with hospitals and ancillary providers Review escalated claim disputes with Health Plans and ancillary providers Liaise to several Health Plans for Contracting and Provider Relations Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form othersPreferred Qualifications: Undergraduate degree At least an intermediate level of knowledge of claims processing systems and guidelines Strong interpersonal skills, establishing rapport and working well with others Strong customer service skills Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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 North American Medical Management, California, Inc (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and managers provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform. The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets. 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.
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.