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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM

 

Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com

 

Job Category:

Network Contracting and Pricing

Country:

US

Postal Code:

53201

Approximate Salary:

Not Specified

Position Type:

Full Time

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Director, Network Management & Contracting - Milwaukee WI

UHG - Milwaukee, Wisconsin

Posted: 11/9/2018

The Director of Network Management & Contracting is a business-minded executive who is able to cultivate, build and maintain win-win relationships with post-acute healthcare providers, provide thought leadership and innovation in the post-acute space, and support sustained growth of  Optum and UnitedHealthcare products.
 
The Director of Network Management & Contracting leads contracting and network management for skilled nursing facility (SNF) networks for all UnitedHealthcare lines of business within a market. This leader builds and refines the SNF network, ensures the network meets all state, federal and business network adequacy requirements, achieves objectives for quality and performance, recommends and drives execution for affordability initatives, and ensures affordable and predictable service for customers and business partners.  The Director of Network Management & Contracting drives collaboration and execution against network strategies,  facilitates product expansion and  implementation, ensures regulatory compliance, adheres to reimbursement structure standards, and supports other key process controls.
 
Primary Responsibilities:
  • Lead SNF network strategy for the market
  • Lead contract negotiations (rates and language)
  • Determine the need for special contract arrangements with providers and be accountable for executing those negotiations
  • Complete market SNF Network management tasks (contracting,  provider relations, gap fills, terminations, etc.)
  • Ensure SNF networks exceed requirements for CMS and State network adequacy compliance, in cooridination with M&R and C&S national leads
  • Represent or provide for representation for local SNF Network management on all Medicare, Medicaid and Commercial affordability meetings. Coordinate with SMEs to align strategy, priorities, and  communication
  • Provide leadership to, and be accountable for the performance of managers and staff
  • Hire new Network staff, and train both the new and existing network staff according to SNF Network Playbook and published policies, procedures, and best practices
  • Collaborate with Optum teams, across Sales, Clinical and related functions, to accomplish enterprise goals
  • Support growth strategies with new and existing Optum partners
  • Ability to create and convey a strategic vision, and translate strategic initiatives into tactical actions
  • Ability to travel throughout the market, interact positively with teams and expand relationships with post-acute providers
  • Ability to analyze data to propose contract models and fee schedules
  • Ability to assess and interpret customer needs and requirements
  • Ability to manage a variety of complex issues while driving key projects
  • Ability to take and manage risks
  • Ability to develop and maintain professional working relationships with skilled nursing home providers in region
  • Ability to work collaboratively with colleagues and staff to create a results-driven, team-oriented environment

Required Qualifications:
  • Undergraduate degree in Business, Healthcare Administration or equivalent experience
  • 4+ years of progressive healthcare management experience with strong preference for managed care or skilled nursing industry experience
  • 2+  years of experience leading Network contracting, management, and/or strategy. Demonstrated leadership skills in business development, and/or new product implementation
  • 2+ years of experience in network management,  handling complex network providers with accountability for business results. Experience managing a medical cost, affordability, and administrative budget strongly preferred
  • 2+ years of experience with provider contracting
  • Possess strong contract negotiation skills and contracting knowledge; Experience working with or negotiating a complex solution to the physician, healthcare community desirable
  • Possess strong strategic, relationship-management, and business acumen, well-grounded in healthcare delivery systems
  • 2+ years of experience working with product pricing development and financial modeling
  • 2 + years of experience with Medicare and Medicaid regulations and requirements including payment guidelines and reimbursement methodologies such as DRGs, RUGS, etc; Comprehension of policies and standards related to Medicare Advantage and Special Need Plans (SNP’s) is essential to the role
    
Preferred Qualifications:
  • Solid knowledge of financial reimbursement methodologies, including pay for performance, incentive-based reimbursement mode
  • Familiarity with local and national market trends in post-acute care, the skilled nursing community and in managed care industry
  • Excellent verbal and written communication skills, strong  presentation 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 from others
  • Strong relationship development and other interpersonal skills; Collaboration with Market and Corporate Senior leaders to develop and execute strategic initiatives for operational improvement and organizational growth; Work cross-functionally across the organization to align company and executive priorities with business development strategy
  • Strong customer service skills, and ability to manage multiple priorities and rapid change
  • PC literacy and proficiency in spreadsheet software
  • Ability to use project planning tools and resources    



UnitedHealth Group is working to create the health care system of tomorrow.

Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.

Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.

Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.

 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.

 

 

Job Keywords: Network Contracting, Milwaukee, WI, Wisconsin

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