1+ months

Specialty Network Contracting Manager - Denver, CO or Telecommute in CO - 919902

Denver, CO 80204 Work Remotely
  • Job Code
    919902

Combine two of the fastest-growing 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)

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In support of Optums mission, vision, and strategic goals, this position is responsible for building and maintaining a high-quality, high-performing specialty contract network. Reporting to the Vice President of Contracting and Payer Strategy, the Specialty Network Contract Manager creates, evaluates, and maintains Optum Cares provider network (specialist physicians, pharmacies, ancillary, facilities, primary care physicians etc.). Success looks like a competitive, stable network that demonstrates the Quadruple Aim and Network Adequacy. You are the first step in the evaluation and negotiation of proposed provider contracts in compliance with federal and state laws, company contract templates, provider strategy, and other key process controls. Ensures contracting tactics foster efficient and effective implementation through delegated and contracting providers. Establishes and maintains strong and trusted business relationships with provider network.

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If you are located in Colorado, you will have the flexibility to telecommute* as you take on some tough challenges.

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Primary Responsibilities:

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  • Works within department strategic vision, objectives, and policies and procedures. Participates in building objectives each year
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  • Regularly meet with cross-functional team to assist in creating, evaluating and adjusting strategy for assigned provider groups to meet overall performance goals. Provides explanations and interpretations within area of expertise
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  • Establish and maintain effective business relationships with potential and existing network providers on behalf of the organization
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  • Participate in various department, leadership, or cross-functional meetings including Medical Directors, finance, operational team, and clinical staff
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  • Recruit/contract specialist providers to build the networks in alignment with the overall growth strategy
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  • Negotiate new contracts to ensure maximum revenue, operational efficiency and compliance
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  • Play key role in the creation of local network and execution of network structure, assuring network adequacy and a high-performing specialist contracted network, who score high on provider satisfaction surveys
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  • Work with operational leaders to ensure effective operational implementation and adherence of payment and authorization practices is handed off appropriately
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  • Ensure specialist providers have in-depth understanding of Optum Care model to navigate AR process, prior auth process, as well as meet quality goals, manage utilization / cost performance, contract performance (e.g. shared savings achieved), contractual obligations. Introduce and advocate company resources to facilitate practice optimization
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  • Maintain open and trusting communication with specialist providers and direct them to appropriate network managers to resolve issues related to credentialing, claims, eligibility, disease management, utilization management, quality, and risk adjustment programs
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  • Collaborate, communicate, and manage specialist provider relationships including but not limited to complete Practitioner Data Forms, Provider Change Forms, membership attribution, Credentialing status, provider directories, system access, and other operational questions as needed
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  • Request detailed analysis of various performance and trending data to identify opportunities to improve network construction and appropriately tier providers. Demonstrated ability to understand performance results and key drivers that impact results
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  • Assess and interpret customer needs and requirements
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  • Identify solutions to non-standard requests and problems
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  • Work with minimal guidance; seek guidance on most complex tasks
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  • Translate concepts into practice
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  • Coach, provide feedback, and guide others
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  • Proven contract negotiation skills
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  • Ability to engage directly with senior-level management, providers
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  • Demonstrate benefits of applicable reimbursement methodology to internal partners and providers
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  • Strong Influencing skills, track record of successful client relationship development and ability to quickly build credibility and gain the confidence of individuals at all levels
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  • Exceptional interpersonal skills with ability to effectively interface and influence both internally and externally with a wide range of people including physicians, office staff, hospital executives, and other health plan staff
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  • Prioritize and organize own work to meet deadlines
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  • Seek information from relevant sources (e.g., COB data; publications; government agencies; providers; provider trade associations) to understand market intelligence information
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  • Ability to work in a matrixed management environment
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  • Strong verbal and written communications skills
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  • Demonstrated comfort with data analysis and report review
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  • Demonstrated experience with making presentations to both small and large groups.
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  • Ability to travel (post-COVID) up to 25% in Colorado geography (primarily Denver, but potentially Colorado Springs). Limited overnight travel
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  • At least an intermediate proficiency with MS Suite (including Word, PowerPoint, Excel and Teams)
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  • Working level of knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.
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  • Working level of knowledge with HEDIS measures, CPT and HCPCS codes
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  • Working level of knowledge of CMS-HCC Risk Adjustment Factor
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  • Interact and consult with manager and 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
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Youll 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.

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Required Qualifications:

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  • 3+ years of experience in a healthcare network management-related role, such as contracting or provider services
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  • 3+ years of experience in fee schedule development using actuarial models
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  • 3+ years of experience using financial models and analysis to negotiate rates with providers
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  • 3+ years of experience in performing network adequacy analysis
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  • 2+ years working with a managed care organization or health insurer; or as a consultant in a network/contract management role, such as contracting, provider services, etc.
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  • In-depth knowledge of Medicare Resource Based Relative Value System (RBRVS)
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  • Intermediate level of knowledge of claims processing systems and guidelines
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
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Preferred Qualifications:

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  • Undergraduate Degree or equivalent work experience
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  • 2+ years of project management or project lead experience
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  • Expertise in physician / facility / ancillary contract reimbursement methodologies, payor contracting
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  • Expertise negotiating physician / facility / ancillary contracts
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  • Established knowledge of local provider community
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  • Assist in creating business strategies through excellent analytical and problem-solving skills with effective follow through
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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 health-related 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)

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Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy

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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.

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

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Job Keywords: Specialty Network Contracting Manager, Network Contracting Manager, Network Contracting, healthcare Network Management, Network Management, Denver, CO, Colorado, Colorado Springs, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, LGBTQ, Women, BIPOC

Categories

Posted: 2021-03-24 Expires: 2021-05-22

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Specialty Network Contracting Manager - Denver, CO or Telecommute in CO - 919902

UnitedHealth Group
Denver, CO 80204

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