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Associate Network Contractor - Cypress, CA
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Cypress, CA Cypress, California |
About this job
Position Description:
The Associate Network Contractor is responsible for developing 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. Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. This candidate will establish and maintain strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties.
Primary Responsibilities:
- Demonstrate understanding of applicable products for different lines of business (e.g., Employer and Individual; Medicare and
- Retirement; Community and State)
- Analyze UCRT associated with products, markets, and/or providers to assess performance against budget
- Evaluate current contract performance to identify potential remediation opportunities and/or cost savings
- Demonstrate understanding of and utilize applicable financial tools (e.g., HPM; PPM; FAT; HCE's RVU/Unit tool) and reports (e.g.,
- internal financial models; external reports) to evaluate performance of current contracts
- Demonstrate understanding of contract language in order to assess financial and operational impact and legal implications of
- requested contract changes
- Demonstrate understanding of competitor landscape within the market (e.g., rates; market share; products; provider networks;
- market intelligence; GeoAccess)
- Seek information from relevant sources (e.g., COB data; publications; government agencies; providers; provider trade associations) to understand market intelligence information
- Implement local, regional, and/or national initiatives and directives (e.g., ICD10; medical necessity language) through contracting
- strategies and communication efforts
- Manage UCRT associated with products, markets, and/or providers to identify potential market strategies
- Identify and share best practices (e.g., payment methodologies; negotiation tactics) with national and regional colleagues
- Modify and/or develop new payment methodologies in order to execute market strategies
- Present and discuss industry and market trends with internal and/or external groups (e.g., customer groups; brokers; professional
- associations; providers) in order to facilitate market strategy development and implementation
- Monitor and/or oversee network performance and industry trends to identify opportunities to refine, develop, and/or implement
- market strategies
- Represent department in internal meetings (e.g., medical management; M&R; C&S) to gather relevant information,
- present/recommend solutions, and provide updates on results/decision/activities
- Develop and/or implement contracting strategies to support new benefits designs and plan
Requirements
Required Qualifications:Preferred Qualifications:
- Associate's Degree.
- 1+ year experience in a network management-related role, such as contracting or provider services.
- The ability to create and edit spreadsheets in Microsoft Excel.
- The ability to create and edit correspondence in Microsoft Word.
- Bachelor's Degree.
- Experience working with Claims
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 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
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