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in Concord, CA
Network Contract Manager - Sacramento, CA, Concord, CA, San Francisco, CA
•30 days ago
Hours | Full-time, Part-time |
---|---|
Location | Concord, CA Concord, California |
About this job
Position Description:
The Network Contracting Manager 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 - 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
Requirements
Required Qualifications:
- 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).
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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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.