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Network Contract Manager, Outpatient - Individual Contributor - Telecommute in KY job at UnitedHealth Group, San Diego

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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)

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

Primary Responsibilities:

  • Recruit and contract with Facility or Outpatient providers to assure OBHS has Commercial, Medicare and Medicaid networks that meet Adequacy and Access standards, client expectations and achieve objectives for unit cost performance and trend management
  • Complete contracting tasks required to add new levels of care/services, provider rate increases, new service locations and Tax ID numbers
  • Complete rate renewals with providers identified for remediation opportunities and/or cost savings
  • Work closely with the SWAT Contracting Team, Provider Relations Team, key internal stakeholders and Project Managers to assure network goals are met
  • Clearly communicate status of large network development and contracting initiatives to internal and external customers

In this Facility or Outpatient contracting role, the emphasis will be on completing all recruitment and contracting activities required for an assigned geographic territory to assure the OBS Commercial, Medicare and Medicaid networks meet Adequacy and Access standards, client expectations and unit cost and trend management goals and objectives.  Working collaboratively across a matrixed organization is required to achieve desired results. The environment is fast paced and demanding, so you will be changing priorities often and reacting to the needs of the marketplace and customers.

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 1+ years of related experience in contracting
  • 1+ years of Facility or OP provider recruitment and contracting experience 
  • 1+ years of experience in fee schedule development using actuarial models
  • 1+ years of experience using financial models and analysis to negotiate rates with Facility or OP providers
  • 1+ years of experience in performing network adequacy analysis
  • Intermediate level of knowledge of claims processing systems and guidelines
  • Reside in the state of Kentucky

Preferred Qualifications:

  • Undergraduate Degree
  • Certified Coder
  • Behavioral Health experience
  • In-depth knowledge of Medicare Resource Based Relative Value System (RBRVS)
  • Advanced understanding of Managed Care Facility and OP contract language
  • Exceptional understanding of Medicaid and Medicare pricing and CMS relativity
  • Medicaid, Medicare Advantage and Commercial Contracting for Behavioral Health
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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)

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

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 country: United States

City: San Diego

Category: Business Operations Specialists, All Other

Location: San Diego, CA, United States

Job posted 2022-06-04

This job is expired

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