Network Contractor - Albuquerque, NM

Position Description:

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)

UnitedHealthcare,
part of the UnitedHealth Group family of companies, is comprised of three
specialized businesses dedicated to meeting the health care benefits needs of
individuals and groups; all part of something greater, but each with a
specialized focus:

UnitedHealthcare Employer & Individual works with individuals, small
businesses and large multi-site employers to provide innovative, affordable
benefits services.



UnitedHealthcare Medicare & Retirement is focused on serving Americans over
the age of 50. It is the largest business dedicated to meeting the growing
health and well-being needs of aging individuals in the nation, serving one in
five Medicare beneficiaries through a comprehensive and diversified array of
products and services through four industry-leading businesses.

Our commitment to helping people
live healthier lives, and to continue the honor, satisfaction, and quality of
the TRICARE military health benefit program is greater than ever. Our efforts
complement the Military Health System to demonstrate the best blend of public
and private health care solutions.It's not just business as usual. It is one of
our proudest endeavors.

UnitedHealthcare Community & State provides high-quality, personalized,
public-sector health care programs that help local government agencies improve
health outcomes for millions of children and low-income and disabled
individuals at an affordable cost.



Together, we're removing the barriers that keep people from receiving the kind
of quality health care that makes a difference. We focus on Integrity,
Compassion, Relationships, Innovation and Performance as we empower people to
achieve better health and well-being.



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 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.

Come
grow and thrive in our culture of innovation and ideas. Because there is no
opportunity greater than the quest to help people live healthier lives.

Required Qualifications:

• High School Diploma or GED
• 3+ years of experience in a network
  management-related role, such as contracting or provider services
• In-depth knowledge of Medicare and Medicaid 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
• Knowledge of credentialing, claims processing systems and guidelines
• 3+ years of experience in performing network adequacy analysis
• 3+ years with current proficiency
  utilizing Microsoft Excel (pivot tables, data sorting and filtering); Word
  (documentation) and PowerPoint (creating presentations)

Preferred Qualification:

• Experience business relationships
  with providers 

Success Factors:

• 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