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?
Hospital Provider Contract Manager--Maryland Heights, MO-311764
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 United Healthcare, a UnitedHealth Group company, provides network-based health and well-being benefits and services for employers and consumers nationwide. We use our strength, diversity and innovation to improve the lives of the more than 18 million people who receive our unique products and services. And our endless pursuit for excellence in everything we do extends to your career as well. Join us today for an inspired and purposeful mix of professional growth opportunities and personal rewards.
Primary Responsibilities:
Initiate and lead negotiations with any or all of the following in accordance with United Healthcare contract templates, reimbursement structure standards, and other key United Healthcare process controls:
- Ancillary providers, moderate volume Hospitals (Tier 2 and 3); and/or large physician groups.
- Manage all facets of relationships the geography-specific set of in-network Ancillary providers, moderate volume (Tier 2 and 3) 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 United Healthcare.
- Accountable for all network development and management activities with ancillary providers, Tier 2 and 3 hospitals, and/or large physician medical groups in accordance with United Healthcare standards and key process controls to achieve market/region/division/company objectives.
- Responsible for leading and implementing network strategy, financial analyses, and language/cost negotiations for a specific set of ancillary providers, Tier 1, 2 and 3 hospitals and/or large physician medical groups.
- Lead negotiations with ancillary providers, Tier 2 and 3 hospitals and/or large physician medical groups in their network geography.
- When applicable, 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.
- Develop and successfully perform to geography-specific unit cost targets.
- Monitor geography-specific unit cost performance and improve competitiveness, breadth, and stability of ancillary, Tier 2 and 3 hospital, and/or large physician medical group networks.
- Develop and successfully implement geography-specific unit cost improvement plans for ancillary, Tier 2 and 3 hospital, and/or large physician medical group networks.
- Determine network adequacy and fill ancillary, Tier 2 and 3 hospital, and/or large physician medical group network gaps at geography-specific competitive rates in accordance with unit cost targets.
- Ensure integrity of ancillary, Tier 2 and 3 hospitals, and/or large physician medical group networks with United Healthcare 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, and provider appeals.
- Provide advice/guidance/recommendations to senior management regarding health care costs, cost savings opportunities, best practices, provider performance issues, and network expansion.
- Maintain highest personal/professional integrity and enforce Principles of Integrity and Compliance.
Qualifications
- 4-8 years in a network development/contract management role, such as 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
- Demonstrated effective negotiation skills and implementation/influencing skills
- 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 claims processing guidelines.
- Experience applying pricing, financial analyses, hospital bill audit results and contract standards and negotiation strategies.
- Problem solving skills, including the ability to systematically analyze complex problems, draw relevant conclusions, and successfully devise/implement appropriate solutions calmly.
- Excellent verbal and written communication 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. Proficient in speaking in both individual and group settings.
- Ability to multi-task, shifting back and forth effectively among multiple activities.
- Possesses good interpersonal skills, establishing rapport and working well with others.
- Demonstrated leadership skills
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. |
