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Network Development Specialist - Telecommute job at UnitedHealth Group, San Jose

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Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)

Jobs related to provider network contract negotiation and pricing support the development of geographically competitive, broad access, stable provider network that is both affordable and predictable.

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. Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties.

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

Primary Responsibilities:

  • Analyzes and investigates
  • Provides explanations and interpretations within area of expertise
  • Uses pertinent data and facts to identify and solve a range of problems within area of expertise
  • Investigates non-standard requests and problems, with some assistance from others
  • Works exclusively within a specific knowledge area
  • Prioritizes and organizes own work to meet deadlines
  • Provides explanations and information to others on topics within area of expertise
  • Evaluates/Analyzes Current Contract and Market Performance:
    • Demonstrates understanding of applicable products for different lines of business (e.g., Employer and Individual; Medicare and Retirement; Community and State)
    • Analyzes UCRT associated with products, markets, and/or providers to assess performance against budget
    • Evaluates current contract performance to identify potential remediation opportunities and/or cost savings
    • Demonstrates understanding of and utilize applicable financial tools (e.g., HPM; PPM; FAT; HCE's RVU/Unit tool) and reports (e.g., internal financial models; external reports) to evaluate performance of current contracts
    • Demonstrates understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changes
    • Demonstrates understanding of competitor landscape within the market (e.g., rates; market share; products; provider networks; market intelligence; GeoAccess)
    • Seeks information from relevant sources (e.g., COB data; publications; government agencies; providers; provider trade associations) to understand market intelligence information
  • Develops/Negotiates/Supports Terms of Agreement with Providers:
    • Balances financial and operational impact of contracts to providers, members, UHN, and different customer groups when developing and/or negotiating contract terms
    • Weighs financial and operational information to evaluate continued provider participation
    • Interacts and consults 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
    • Demonstrates understanding of and utilize applicable financial tools (e.g., HPM; PPM; FAT; HCE's RVU/Unit tool) and reports (e.g., internal financial models; external reports) to develop rates
    • Demonstrates understanding of contract policies to ensure compliance and consistent contracting across the enterprise
    • Demonstrates understanding of contract language and terms of agreement in order to ensure that financial/operational impact and legal implications are aligned with business objectives
    • Utilizes appropriate contract management systems (e.g., Emptoris; PEGA; Contract Attachment Repository) to author and execute contracts and to access supplemental contractual documents
    • Demonstrates understanding of submission tools (e.g., Delegation Authority Grids; loading grids; Navigator; BPM) to ensure accurate and timely contract configuration for customer groups
    • Demonstrates understanding of contractual financial and non-financial terms
    • Evaluates market rates and provider performance (e.g., billing patterns; referral patterns; quality and effectiveness) in order to establish provider rates and negotiation strategies
    • Communicates proposed contractual terms with provider and negotiate mutually acceptable agreement
  • Manages Provider Relationships:
    • Explains the organization's direction and strategy to internal partners and providers in order to justify methodologies, processes, policies, and procedures
    • Demonstrates benefits of applicable reimbursement methodology to internal partners and providers
    • Identifies and gathers information regarding provider issues in order to develop and/or implement strategy to resolve matter, keep manager informed of progress, or escalate issue to appropriate internal business partner
    • Represents department in external meetings (e.g., ancillary providers; physician groups; facilities) to gather relevant information, recommend solutions, execute on deliverables as assigned and explain results / decision / activities
    • Reports back information from provider meetings to applicable stakeholder (e.g., manager; business partner) in order to determine appropriate action
    • Monitors and/or oversees provider financial performance to identify opportunities to improve performance and/or provider relationship
    • Communicates contractual and/or operational performance to providers to ensure compliance with contractual terms and protocols
    • Demonstrates understanding of provider termination process
    • Educates providers on the organization's processes, policies, and procedures in order to ensure provider compliance and ease of administration
  • Develops/Implements/Executes/Supports Market Strategies:
    • Implements local, regional, and/or national initiatives and directives (e.g., ICD10; medical necessity language) through contracting strategies and communication efforts
    • Manages UCRT associated with products, markets, and/or providers to identify potential market strategies
    • Identifies and shares best practices (e.g., payment methodologies; negotiation tactics) with national and regional colleagues
    • Modifies and/or develop new payment methodologies in order to execute market strategies
    • Presents and discusses industry and market trends with internal and/or external groups (e.g., customer groups; brokers; professional associations; providers) in order to facilitate market strategy development and implementation
    • Monitors and/or oversees network performance and industry trends to identify opportunities to refine, develop, and/or implement market strategies
    • Represents 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
    • Develops and/or implements contracting strategies to support new benefits designs and plans

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
  • 3+ years of experience in a network management-related role, such as contracting or provider services
  • Experience utilizing MS Office suite including Word and Excel at an intermediate proficiency

Preferred Qualifications: 

  • In-depth knowledge of Medicare reimbursement methodologies, i.e., Resource Based Relative Value System (RBRVS)
  • 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
  • Solid interpersonal skills, establishing rapport and working well with others
  • Solid customer service skills

Values Based Competencies

  • Integrity Value: Act Ethically
    • Comply with Applicable Laws, Regulations and Policies
    • Demonstrate Integrity
  • Compassion Value: Focus on Customers
    • Identify and Exceed Customer Expectations
    • Improve the Customer Experience
  • Relationships Value: Act as a Team Player
    • Collaborate with Others
    • Demonstrate Diversity Awareness
    • Learn and Develop
  • Relationships Value: Communicate Effectively
    • Influence Others
    • Listen Actively
    • Speak and Write Clearly
  • Innovation Value: Support Change and Innovation
    • Contribute Innovative Ideas
    • Work Effectively in a Changing Environment
  • Performance Value: Make Fact-Based Decisions
    • Apply Business Knowledge
    • Use Sound Judgement
  • Performance Value: Deliver Quality Results
    • Drive for Results
    • Manage Time Effectively
    • Produce High-Quality Work

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 WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 380,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team 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 Jose

Category: Business Operations Specialists, All Other

Location: San Jose, CA, United States

Job posted 2022-06-04

This job is expired

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