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Hours Full-time, Part-time
Location Cypress, CA
Cypress, California

About this job


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)


The Senior 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.


This position is not intended to do specific provider negotiation but will work on constructing capitated provider contract templates including base agreements and amendments. Position will work with other departments to formulate the associated contract language for regulatory and operational updates. Additionally, person will serve as Network Management liaison for internal work groups including the IHA program implementation. This role will also manage and organize the annual playbook meeting for the Network Management team.



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

  • Balance financial and operational impact of contracts to providers, members, UHN, and different customer groups when developing

  • and/or negotiating contract terms

  • Weigh financial and operational information to evaluate continued provider participation

  • Interact and consult with Network Pricing team to evaluate different financial arrangements and to identify and recommend

  • applicable payment methodologies (e.g., FFS; Case Rate; Sub-capitation; Pay for Performance) in order to maximize value for

  • stakeholders

  • 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 develop rates

  • Demonstrate understanding of contract policies to ensure compliance and consistent contracting across the enterprise

  • Demonstrate understanding of contract language and terms of agreement in order to ensure that financial/operational impact and legal implications are aligned with business objectives

  • Utilize appropriate contract management systems (e.g., Emptoris; PEGA; Contract Attachment Repository) to author and execute

  • contracts and to access supplemental contractual documents

  • Demonstrate understanding of submission tools (e.g., Delegation Authority Grids; loading grids; Navigator; BPM) to ensure

  • accurate and timely contract configuration for customer groups

  • Demonstrate understanding of contractual financial and non-financial terms

  • Evaluate market rates and provider performance (e.g., billing patterns; referral patterns; quality and effectiveness) in order to

  • establish provider rates and negotiation strategies

  • Communicate proposed contractual terms with provider and negotiate mutually acceptable agreement

  • Explain the organization's direction and strategy to internal partners and providers in order to justify methodologies, processes,

  • policies, and procedures

  • Demonstrate benefits of applicable reimbursement methodology to internal partners and providers

  • Identify and gather information regarding provider issues in order to develop and/or implement strategy to resolve matter, keep

  • manager informed of progress, or escalate issue to appropriate internal business partner

  • Represent department in external meetings (e.g., ancillary providers; physician groups; facilities) to gather relevant information,

  • recommend solutions, execute on deliverables as assigned and explain results/decision/activities

  • Report back information from provider meetings to applicable stakeholder (e.g., manager; business partner) in order to determine

  • appropriate action

  • Monitor and/or oversee provider financial performance to identify opportunities to improve performance and/or provider relationship

  • Communicate contractual and/or operational performance to providers to ensure compliance with contractual terms and protocols

  • Demonstrate understanding of provider termination process

  • Educate providers on the organization's processes, policies, and procedures in order to ensure provider compliance and ease of

  • Administration.

  • 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 plans

Requirements

Required Qualifications:



  • Associate's Degree.

  • 5+ years experience in a Network Management-related role handling complex network providers with accountability for business results.

  • 5+ years experience in the Healthcare Industry.

  • Knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.

  • 2+ years experience in contributing to the development of product pricing and utilizing financial modeling in making rate decisions.

  • 3+ years of experience working with capitated medical groups and hospitals especially pertaining to contract negotiations.

Preferred Qualifications:

  • Bachelor's Degree.
  • Experience in contributing to the development of product pricing
    and utilizing financial modeling in making rate decisions.
  • Experience with provider contracting.


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


Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.


UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.