Job Details
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
The Sr Network Contract Manager is responsible for the management of contract strategy development, negotiations, and relationship management of valued based and fee for service agreements with payer organizations. This role is accountable for the development, improvement, and successful management of payer contracts for a physician organization in the Midwest region, currently Ohio and Indiana, but with future geographical expansion. This role will be a telecommute position, with a work-from-home field team. Limited travel requirements.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Critical performance responsibilities:
- Compiles and maintains accurate and timely information on contract performance for all fee for service and value-based contracts in a database, including renewal dates, cancelation notices and provider relations contacts
- Assist in the development of a fee for service and value-based contracting strategy for Medicare, Commercial and Medicaid lines of business
- Identify, analyze and interpret Optum’s payer contract performance (e.g., billing patterns; referral patterns; quality and effectiveness) in order to establish negotiation opportunities and solutions
- Interact and consult with Healthcare Medical Economics and physician organization leadership teams to evaluate and monitor financial performance for applicable payment methodologies (e.g. FFS, Case Rate, Capitation, Pay for Performance, Value Based Risk) in order to maximize value for stakeholders
- Evaluate Market rates, inflationary impacts and payer performance in order to establish target rates per market and negotiation strategies
- Demonstrate understanding of contract language and terms of agreement to draft and redline agreements and ensure legal, financial and operational implications are aligned with business objectives
- Negotiates contracts in compliance with Optum’s contract strategy, templates, reimbursement structure standards, and other key process controls
- Present and discuss strategy, financial reimbursement methodologies, financial models, contract language and operational impact to stakeholders and leadership in order to facilitate market strategy development and implementation
- Work with all levels of Optum’s leadership to evaluate or monitor contract performance to determine necessity for amendments or extensions of contracts and compliance to contractual obligations
- Effectively communicate with Director regarding contracting progress, escalation of key decisions or issues while ensuring proper escalation to internal business partners
- Critical relationship responsibilities:
- Educate internal teams on the contractual terms, payor requirements, policies, and procedures in order to ensure compliance and ease of Administration
- Explain the organization’s direction and strategy to internal partners and leadership in order to justify methodologies, processes, policies and agreements
- Create and communicate a transition with the payers between payer strategy and payer development teams for effective contract implementation and ongoing management
- Develops and maintains solid working relationships with functional areas including but not limited to leadership, legal, clinical management, operations, finance, billing, national contracting and others to develop and articulate comprehensive solutions to market needs
- Deliver solid organizational and communication skills to effectively communicate with physician organization’s leadership team regarding contracting progress, escalation of key decisions or issues
- Represent department in external meetings to gather relevant information, recommend solutions, execute on deliverables as assigned and explain results/decision/activities
- Consistently exhibits behavior and communication skills that demonstrate the organization’s commitment to superior customer service, including concern with all internal and external customers
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:
- 3+ years working in payor/provider contracting
- Experience being in an external facing role, representing your organization with clients, vendors and/or government officials
- Experience managing complex meetings and/or projects
- Demonstrated success / experience working in a highly matrixed organization
- Demonstrated success working in dynamic, fast-paced environment
- Demonstrated ability to effectively interface with teammates, clinicians, and management
Preferred Qualification:
- Experience contracting in commercial plans and Medicare
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for this role is $88,000 to $173,200 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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
UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are... Read more