UnitedHealth Group is among the most ambitious Fortune 25 companies you'll ever meet. Through our family of businesses, we're working to make the health care system perform better for more people, in more ways than ever.
Simply put, we think the entire system can be greater than it's ever been. And that drives us to work harder, aim higher, and expect more from one another.
Here, you'll be empowered to make an immediate impact for millions of others. And you'll achieve more than you ever expected. How does that fit with your plans?
Provider Network Contract Manager--Baton Rouge-312669
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description
UnitedHealthcare is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
When you work with UnitedHealthcare, what you do matters. It's that simple...and it's that challenging.
In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.
Primary Responsibilities:
- Initiate and lead negotiations with any or all of the following in accordance with UnitedHealthcare contract templates, reimbursement structure standards, and other key UnitedHealthcare process controls:
- Moderate volume Hospitals; and/or Large Physician groups
- Manage all facets of relationships the geography-specific set of in-network providers, moderate volume Hospitals, and/or large Physician groups yielding a geographic-specific competitive, broad access, stable provider network that achieves objectives for unit cost performance and yields an affordable and predictable product for customers.
- Develop and execute negotiation strategies that directly impact financial performance of UnitedHealthcare.
- Accountable for all network development and management activities with hospitals, and/or large physician medical groups in accordance with UnitedHealthcare standards and key process controls to achieve market/region/division/company objectives.
- Lead and implement network strategy, financial analyses, and language/cost negotiations for a specific set of hospitals and/or large physician medical groups.
- Lead negotiations with hospitals and/or large physician medical groups in their network geography.
- Work with and involve relevant stakeholders (regional and corporate network management, internal customers, network pricing, etc.) in negotiation decisions impacting legal or regulatory requirements, contract standards and cost targets.
- Monitor geography-specific unit cost performance and improve competitiveness, breadth, and stability of hospital, and/or large physician medical group networks.
- Develop and successfully implement geography-specific unit cost improvement plans for hospital, and/or large physician medical group networks.
- Determine network adequacy and fill hospital, and/or large physician medical group network gaps at geography-specific competitive rates in accordance with unit cost targets.
- Ensure integrity of hospitals, and/or large physician medical group networks with UnitedHealthcare policies and compliance with pertinent regulatory guidelines.
- Accountable for relevant components of provider relationship management, including leading Joint Operating Committee (JOC) meetings, as necessary, and provider outreach/communication.
- Promote use of electronic provider on-line self-service tools in order to support and achieve operational efficiency yielding reduced costs to serve the relationship.
- Perform and monitor activities related to the contract load process, engage appropriate service organization for claims resolution, ARO, EDI, provider service/performance issues as well as provider appeals.
- Provide advice/guidance/recommendations to senior management regarding health care costs, cost savings opportunities, best practices, provider performance issues, as well as network expansion.
- Maintain highest personal/professional integrity and enforce Principles of Integrity and Compliance.
Regardless of your role at UnitedHealthcare, the support you feel all around you will enable you to do what you do with energy, integrity, and confidence. So take the first step in what is sure to be a fast paced and highly diversified career.
Qualifications
- Four to eight years in a network development/contract management role, such as hospital/physician contracting, etc.
- Bachelor's degree in business, health care management, or related field.
- Significant additional experience may be considered in lieu of a Bachelors degree, at the discretion of the hiring manager.
- High degree of proficiency in utilizing and interpreting financial models and network adequacy analyses.
- Strong knowledge of RBRVS, Ambulatory Surgery Center groupers, per diem, per case, DRG and APC reimbursement methodologies and clear understanding of Medicare and UnitedHealthcare claims processing guidelines.
- Experience applying pricing, financial analyses, hospital bill audit results and contract standards to the development of Requests for Proposals and negotiation strategies.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. |
