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Network Contract Manager - Remote in Draper, UT

Company: UnitedHealth Group
Location: Draper
Posted on: November 18, 2022

Job Description:

Combine two of the fastestgrowing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) Job Family DescriptionJobs related to provider network contract negotiation and pricing support the development of geographically competitive, broad access, stable provider network that is both affordable and predictable. Job Function DescriptionDevelops 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. Establishes and maintains solid business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties. General Job Profile Generally work is selfdirected and not prescribed Works with less structured, more complex issues Serves as a resource to others If you are located in UT, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Assesses and interprets customer needs and requirements Identifies solutions to nonstandard requests and problems Solves moderately complex problems and/or conducts moderately complex analyses Works with minimal guidance; seeks guidance on only the most complex tasks Translates concepts into practice Provides explanations and information to others on difficult issues Coaches, provides feedback, and guides others Acts as a resource for others with less experience You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Undergraduate degree or equivalent experience Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation Functional Competency & Description PCN_Evaluate/Analyze Current Contract and Market Performance 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 PCN_Develop/Negotiate/Support Terms of Agreement with Providers 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; Subcapitation; 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 nonfinancial 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 PCN_Manage Provider Relationships 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 PCN_Develop/Implement/Execute/Support Market Strategies 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 C) 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 Preferred Qualifications: Values Based Competencies Integrity Value: Act Ethically Comply with Applicable Laws, Regulations and Policies Demonstrate Integrity Compassion Value: Focus on Customers Identify and Exceed Customer Expectations Improve the Customer Experience Relationships Value: Act as a Team Player Collaborate with Others Demonstrate Diversity Awareness Learn and Develop Relationships Value: Communicate Effectively Influence Others Listen Actively Speak and Write Clearly Innovation Value: Support Change and Innovation Contribute Innovative Ideas Work Effectively in a Changing Environment Performance Value: Make FactBased Decisions Apply Business Knowledge Use Sound Judgement Performance Value: Deliver Quality Results Drive for Results Manage Time Effectively Produce High Quality Work To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID19 vaccination regulations as well as all client COVID19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of healthrelated information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy 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.

Keywords: UnitedHealth Group, Draper , Network Contract Manager - Remote in Draper, UT, Executive , Draper, Utah

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