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Sr. Network Contract Manager- Telecommute from Florida job at UnitedHealth Group, Atlanta

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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)



The Sr. Network Development Manager is responsible for negotiating and supporting terms of agreement with Specialty and Ancillary providers 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 Specialty and Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties. 



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



Primary Responsibilities:




  • Recruit and contracts with Specialty/Ancillary providers to ensure adequacy standards are met, through ways of targeted chase list(s) and expansion market(s)

  • Negotiates and support terms of agreement with Specialty and Ancillary providers 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

  • Demonstrates understanding of contract language in order to assess financial and operational impact, including legal implications of requested contract changes, aligned with business objectives

  • Demonstrates understanding of contract policies to ensure compliance and consistent contracting across the Enterprise

  • Demonstrates knowledge of competitive landscape within respective market space (e.g. rates, market share, product lines, market intelligence, GeoAccess)

  • Establishes and maintains strong business relationships with Specialty and Ancillary providers, ensuring the network composition includes an appropriate distribution of provider specialties to meet adequacy

  • Implements and support local, regional and/or national initiatives and directives through contracting strategies and communication efforts

  • Implements contracting strategies to support new benefit designs and plans

  • Ensures relevant contract and demographic information is loaded, timely, accurate and consistent in applicable platform(s) in order to support network review

  • Ensure processes are consistent with CMS, state, and federal regulations and guidelines

  • Performs all other related duties as assigned





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 work experience

  • 3+ years experience in a network management related role, such as contracting/recruiting or provider services

  • 2+ years experience using financial models and analysis to negotiate rates with providers

  • Proficiency with Microsoft Office applications to include Word, Excel, Visio, PowerPoint, SharePoint, Microsoft Teams and Outlook

  • Ability to travel up to 25%. 

  • 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



Preferred Qualifcations:




  • 3+ years experience in fee schedule development using actuarial models

  • Work experience directly or indirectly with a Managed Service Organization (MSO) and firm understanding of value-based care model and Medicare Advantage products

  • Intermediate level of knowledge of claims processing systems and guidelines

  • Working knowledge of health care reimbursement practices, utilization management requirements, claims handling procedures, health insurance benefit administration and risk-based reimbursement

  • Ability to solve moderately complex problems and adapt to process variances in situations where limited standardization exists

  • Excellent written and presentation skills in order to easily communicate to diverse audiences

  • Exceptional time management and organizational skill(s) to balance multiple priorities in a fast paced working environment



Physical & Mental Requirements: 




  • Ability to sit for extended periods of time

  • Ability to use fine motor skills to operate office equipment and/or machinery

  • Ability to receive and comprehend instructions verbally and/or in writing

  • Ability to use logical reasoning for simple and complex problem solving





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 550,000+ 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)



WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.



*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.



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


Job country: United States

City: Atlanta

Category: Business Operations Specialists, All Other

Location: Atlanta, GA, United States

Job posted 2022-06-04

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