Sr Network Contract Mgr - CA or Remote

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM

Clinical

Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

The more you do, the more you learn. And as you learn you find new doors opening that challenge you to bring your best. This leadership role with UnitedHealth Group will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. You'll guide the development and support of Provider Networks as well as unit cost management activities through financial and network pricing modeling, analysis and reporting. As you do, you'll discover the impact you want and the resources, backing and opportunities that you'd expect from a Fortune 5 leader.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:
  • Manage unit cost budgets, target setting, performance reporting and associated financial models
  • Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance, trend management and appropriate distribution of provider specialties
  • Evaluate and negotiate contracts in compliance with company templates, reimbursement structure standards and other key process controls
  • Establishes and maintains strong business relationships with Hospital, Medical Groups, Physicians, or Ancillary Providers
  • Serves as a leader/mentor
  • Evaluate current contract performance to identify potential remediation opportunities and/or cost savings
  • Demonstrate understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changes
  • Balance financial and operational impact of contracts to providers, members, UHN, and different customer groups when developing and/or negotiating contract terms
  • 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
  • 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
  • Explain the organization's direction and strategy to internal partners and providers in order to justify methodologies, processes, policies, and procedures
  • Report back information from provider meetings to applicable stakeholder (e.g., manager; business partner) in order to determine appropriate action
  • 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
  • Implement local, regional, and/or national initiatives and directives (e.g., ICD10; medical necessity language) through contracting strategies and communication efforts
  • Represent department in internal meetings (e.g., medical management; M&R; C&S) to gather relevant information, present/recommend solutions, and provide updates on results/decision/activities
  • 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; Sub-capitation; Pay for Performance) in order to maximize value for stakeholders


In this role, you will need to be able to thrive in a demanding, intense, fast-paced environment. In addition, you'll be driving some complex negotiations while striving to ensure accuracy.

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:
  • 5+ years of experience in a network management-related role handling complex network providers with accountability for business results
  • 5+ years of experience in the health care industry
  • 5+ years of experience with provider contracting including development of product pricing and utilizing financial modeling in making rate decisions
  • In-depth knowledge of Capitated/Delegated contract arrangements, Medicare Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.
  • 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

Preferred Qualification:
  • Undergraduate degree


Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans wherever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy

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. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives

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.

Job Keywords: Sr Network Contract Manager, Rancho Cordova, Contracting, Negotiate, Negotiation, Network, Hospital, Physician, Telecommute, Remote, Work from Home

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