Develops the provider network (hospitals, ancillary groups & facilities) 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.
Establishes and maintains strong business relationships with Hospital and Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties.
- Works with minimal guidance; seeks guidance on only the most complex tasks
- 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
- Balance financial and operational impact of contracts to providers, members, UHN, and different customer groups when developing and/or negotiating contract terms
- 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
- Identify and share best practices (e.g., payment methodologies; negotiation tactics) with national and regional colleagues
- Represent department in internal meetings to gather relevant information, present/recommend solutions, and provide updates on results/decision/activities
- Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management
- Evaluate, negotiate, and manage implementation of contracts in compliance with company templates, reimbursement structure standards and other key process controls
This is an intense, fast paced environment that requires self-direction, working with a variety of complex issues. A positive attitude and the ability to collaborate with others is key to your success.
- Undergraduate degree or equivalent work experience
- 3+ years of experience in a network management-related role, such as contracting or provider services
- 3+ years of experience using financial models and analysis to negotiate rates with providers
- Intermediate MS Office proficiency (Excel, Word, Outlook, and PowerPoint)
- Knowledge of provider reimbursement methodologies
- Must live within a commutable distance of this specific career opportunity
- Must be willing and able to travel a maximum of 25% of the time locally
- Knowledge of claims processing systems and guidelines
- Demonstrate understanding of applicable products for different lines of business (e.g., Employer and Individual; Medicare and Retirement; Community and State)
- Demonstrate understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changes
Creating and fine tuning provider networks helps improve access to health care for millions. It's an outstanding opportunity to have more meaning and purpose in your career. Join us. Find out how you can start doing your life's best work.(sm)
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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: 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: Cleveland, OH, Ohio, Network Contract Manager, Hospital, Ancillary, Contracting, Negotiation, Network, Provider