Sr Manager of Payor Contracting - Washington or Oregon - Remote
Hybrid
Seattle, WA, United States(flexible)
Seattle, WA, United States(flexible)
Posted 14 days ago
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. Manager of Payor Contracting supports the VP and Director of Payor Contracting in negotiating assigned agreements which benefit Optum, the healthcare professionals it represents, and the patients it serves. This position is responsible for leading assigned health plan negotiations, drafting and managing contracts, serving as an organizational subject matter expert on existing FFS and risk agreements for the WA/OR/ID/UT Market, and researching and resolving payor issues. Role will not have direct reports, but will require solid collaboration with multiple teams (Provider Contracting, Contract Operations, Regional Operations, UM, QM, Claims, Finance, Analytics, etc). This individual will represent Payor Contracting in interdepartmental initiatives, as assigned. If you are located in the Northwest (Washington, Oregon, Idaho, California, or Utah), you’ll enjoy the flexibility to work remotely *as you take on some tough challenges. Primary Responsibilities:
- Leads contract negotiations, as assigned. This may include, but is not limited to, risked based agreements, fee-for-service negotiations, quality, and ACO agreements with health plans
- Manages contractual relationships with payers and internal stakeholders
- Reviews health plan contract language, and is familiar with payor, medical group/IPA, and hospital/ancillary contract language and reimbursement mechanisms
- Circulates draft contract terms/language to various internal departments, including Legal, Finance, Claims, Quality and Medical Management teams for review & approval
- Applies knowledge of healthcare delivery system, IPA operations, managed care, healthcare laws in assisting with the development of contracting strategies
- Answers and/or resolves inquiries from health plans or internal departments in a timely manner
- Establishes good working relationships with health plan representatives, as well as internal teamsDevelops tools (e.g., dashboards, grids, tables, summaries) as needed to provide organizational leadership key contract data
- Team development (coaching and mentoring of team)
- Project Management - various ad-hoc requests with short turnaround time
- Other duties as assigned
- 3+ years of experience in managed care contracting/contract administration
- Direct experience leading health plan/provider negotiations
- Experience with financial models analyzing health plan agreements
- Experience with government programs (Medicare, Medicaid)
- Advanced MS Word capabilities: find & replace, redlining, comment insertion, track changes and document compare
- Proficient in MS Excel and PowerPoint software
- Health plan or provider group/IPA experience
- Experience with capitation, and risk sharing arrangements
- Solid teammate management experience
- Supervisory experience
- Proven ability to manage a team with a wide range of skills and professional developmental needs
- Proven ability to make independent decisions
- Proven ability to change thought patterns quickly
- Proven ability to multitask
- Proven high attention to detail and personal organization
- Evaluate/Analyze Current Contract and Market Performance C) Fully Proficient
- Develop/Negotiate/Support Terms of Agreements C) Fully Proficient
- Manage Payer Relationships C) Fully Proficient
- Develop/Implement/Execute/Support Market Strategies C) Fully Proficient
Learn more about UnitedHealth Group
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