Healthcare Hospital Provider Network Contract Manager - Nashville / Knoxville, TN

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The Network Contract Manager develops the provider network (hospitals) 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.

In this role you will be expected to:
- 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 experience.
- Position may be located in either Nashville or Knoxville.

 

Develops the provider network (hospitals) 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.  Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties.
- Generally work is self-directed and not prescribed.
- Works with less structured, more complex issues.
- Serves as a resource to others.

Requirements:
- Undergraduate degree
- 4+ years of experience 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.
- At least an intermediate level of knowledge of claims processing systems and guidelines.
- 3+ years of experience in performing network adequacy analysis.
- 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 others.
- Strong interpersonal skills, establishing rapport and working well with others.
- Strong customer service skills

Job Keywords:  Healthcare, Managed Care, Hospital Contracting, Physician Contracting, Ancillary Contracting, Provider Network, Network Development, Provider Services, Contract Negotiating, Network Management

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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.