Senior Network Contract Manager (Providers) - Ontario, CA at UnitedHealth Group in Ontario, California

Posted in Other 19 days ago.

Type: Full-time

Job Description:

The Senior Network Contract Manager develops 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.

Primary Responsibilities:
  • Evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls
  • Identify potential contract issues and impacts on the business.
  • Builds relationships that nurture Hospital, Physician, Pharmacy, or Ancillary Provider partnerships and seeks broader value-based business opportunities to support the local market strategy.
  • Evaluate and negotiate contracts
  • Ensure the network composition includes an appropriate distribution of provider specialties
  • Adapt departmental plans and priorities to address business and operational challenges
  • Set team direction, resolve problems and provide guidance to members of own team
  • Influence or provide input to forecasting and planning activities
  • May oversee work activities of other supervisors
  • Product, service or process decisions are most likely to impact multiple groups of employees and/or customers (internal or external).
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
  • 5+ years' experience in a Network Management-related role handling complex Network Providers with accountability for business results
  • Proven strong contract negotiating skills
  • Expert level of knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.
  • 2+ years' experience in the following areas:
    • Contributing to the development of product pricing and utilizing financial modeling in making rate decisions
    • Managing a medical cost and administrative budget
    • Provider contracting
    • Supervising or Managing a team
  • Intermediate proficiency in MS Word, Excel, and Outlook

Preferred Qualifications:
  • Undergraduate degree or equivalent experience
  • Strong customer service skills
  • 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 form others, including but not limited to reimbursement policy standards
  • Strong interpersonal skills, establishing rapport and working well with others

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)

North American Medical Management, California, Inc. (NAMM) develops and manages clinician networks, offering a full range of services to assist physicians and other clinicians in their managed care and business operations. For over 17 years, NAMM has been an innovator in health care with a track record for quality, financial stability, extraordinary services and superior electronic capabilities. Prime Care Medical Network is a key affiliate.

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

Job Keywords: Network Operations, Provider contract, Network contract, manager, negotiating, direct reports, Medicare, Reimbursement, RBRVS, DRG, Ambulatory Surgery Center Goupers, financial modeling, budget, IPA, performance Improvements, hospitalist, Word, Excel, PowerPoint, Ontario, CA, California