Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
In support of Optum’s 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 Care’s 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.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Works within department strategic vision, objectives, and policies and procedures. Participates in building objectives each year
- 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
- Establish and maintain effective business relationships with potential and existing network providers on behalf of the organization
- Participate in various department, leadership, or cross-functional meetings including Medical Directors, finance, operational team, and clinical staff
- Recruit/contract specialist providers to build the networks in alignment with the overall growth strategy
- Negotiate new contracts to ensure maximum revenue, operational efficiency and compliance
- 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
- Work with operational leaders to ensure effective operational implementation and adherence of payment and authorization practices is handed off appropriately
- 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
- 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
- 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
- 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
- Assess and interpret customer needs and requirements
- Identify solutions to non-standard requests and problems
- Work with minimal guidance; seek guidance on most complex tasks
- Translate concepts into practice
- Coach, provide feedback, and guide others
- Proven contract negotiation skills
- Ability to engage directly with senior-level management, providers
- Demonstrate benefits of applicable reimbursement methodology to internal partners and providers
- Solid Influencing skills, track record of successful client relationship development and ability to quickly build credibility and gain the confidence of individuals at all levels
- 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
- Prioritize and organize own work to meet deadlines
- Seek information from relevant sources (e.g., COB data; publications; government agencies; providers; provider trade associations) to understand market intelligence information
- Ability to work in a matrixed management environment
- Solid verbal and written communications skills
- Demonstrated comfort with data analysis and report review
- Demonstrated experience with making presentations to both small and large groups.
- Ability to travel (post-COVID) up to 25%25 in Colorado geography (primarily Denver, but potentially Colorado Springs). Limited overnight travel
- At least an intermediate proficiency with MS Suite (including Word, PowerPoint, Excel and Teams)
- Working level of knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.
- Working level of knowledge with HEDIS measures, CPT and HCPCS codes
- Working level of knowledge of CMS-HCC Risk Adjustment Factor
- 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
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:
- 3+ years of experience in a healthcare network management-related role, such as contracting or provider services
- 3+ years of experience in fee schedule development using actuarial models
- 3+ years of experience using financial models and analysis to negotiate rates with providers
- 3+ years of experience in performing network adequacy analysis
- 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.
- In-depth knowledge of Medicare Resource Based Relative Value System (RBRVS)
-
Intermediate level of knowledge of claims processing systems and guidelines
Preferred Qualifcations:
- Undergraduate Degree or equivalent work experience
- 2+ years of project management or project lead experience
- Expertise in physician / facility / ancillary contract reimbursement methodologies, payor contracting
- Expertise negotiating physician / facility / ancillary contracts
- Established knowledge of local provider community
- Assist in creating business strategies through excellent analytical and problem-solving skills with effective follow through
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.