Network Contract Manager - Wauwatosa or Green Bay, WI.

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.

In this role you will:

- Advance Medicare & Retirement initiatives - STARS, PCOR, MAPCPi, network restructuring, remediation and affordability agendas

-Advance Community & State initiatives - growth (BadgerCare Plus and D-SNP)

-Improve provider relationships, affordability agenda

-Maintain strong IPA partnerships

-Improve network footprint in rural markets to support growth initiative

-Collaborate with and build strong relationships with operations to advance excellence in provider data loading and timely contract execution and maintenance 
 

Requirements/Assets:

- 5+ years experience in a network management-related role, such as contracting or provider services.

- 2+ years of experience in performing network adequacy analysis.

- 2+ years of experience utilizing financial models and analysis in negotiating rates with providers.

- 3+ years experience with claim resolution

- 3+ years experience with claims processing systems 

- 2+ years experience with commercial, Medicare or Medicaid products

- In-depth knowledge of Medicare reimbursement methodologies, i.e. Resource Based Relative Value System (RBRVS).
- 1+ years of experience in fee schedule development using actuarial models.
- Excellent verbal and written communication skills

- Strong relationship skills 
- Undergraduate degree or equivalent work experience

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 17 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

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.