Network Contract Manager - Sacramento, CA, Concord, CA, San Francisco, CA

• 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


• 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

• Bachelor's Degree.
• Ability to travel 25% of the time.
• 4+ years experience in a network management-related role, such as contracting or provider services.
• Experience working with Fee schedules.
• 3+ years of experience utilizing Financial models and Analysis in negotiating rates with providers.
• 3+ years of experience working with capitated medical groups and hospitals especially pertaining to contract negotiations. 
• Microsoft Office (MS Word, MS Excel, MS Outlook, MS PowerPoint) experience.

• Experience in performing Network Adequacy Analysis.
• Knowledge of Claims Processing Systems and guidelines.
• Medicare reimbursement methodologies experience , i.e. Resource Based Relative Value System (RBRVS).

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.