This self-directed role with OptumHealth will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. You will manage direct reports, contracts, cost trend, relationships and network growth/strategy for Optum's Behavioral Health National provider networks through provider negotiations with large outpatient groups, facilities and other health systems. This position is responsible for executing network strategies to meet client and sales goals; contracting competitive rates; evolving the payment methodology to align with the line of business; and managing high-volume provider relationships.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:- Analyze and evaluate payment appendices to strategize options for various contracting approaches and methodologies
- Evaluate market rates and provider performance (e.g., billing patterns; referral patterns; quality and effectiveness) in order to establish provider rates and negotiation strategies
- Explain the organization's direction and strategy to providers in order to justify methodologies, processes, policies, and procedures
- Input contract projections accurately into appropriate tools and analyze financial impact of provider contracts to achieve company goals
- Communicate proposed contractual terms with provider and negotiate mutually acceptable agreement
- Establish and manage relationships with providers to navigate operational, legal, financial and clinical matters
- Lead, develop, and mentor a team of provider contracting professionals, establishing clear performance expectations, fostering professional growth, and driving accountability to organizational goals.
- Oversee workload prioritization, resource allocation, and team performance to ensure timely execution of contracting initiatives, provider negotiations, and strategic network objectives.
- Conduct performance evaluations, provide ongoing coaching and feedback, and create development plans that enhance employee engagement, capability, and succession readiness.
- Partner with senior leadership to establish departmental goals, implement strategic initiatives, and drive continuous improvement across contracting processes and team operations.
- Serve as an escalation point for complex provider negotiations, contract disputes, operational challenges, and relationship management issues, ensuring effective resolution and alignment with company objectives.
- Recruit, onboard, and retain top talent while cultivating an inclusive, high-performing culture focused on collaboration, innovation, and results.
- Promote cross-functional collaboration among Contracting, Finance, Healthcare Economics, Network Operations, Provider Services, Legal, and Clinical teams to achieve organizational priorities and strengthen network performance.
- Monitor team productivity, contracting outcomes, financial results, and key performance indicators, implementing corrective actions and process improvements as needed to optimize departmental performance.
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 directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- 8+ years of experience in a network management-related role handling complex network providers with accountability for business results
- 8+ years of experience in the health care industry
- 6+ years of experience with provider contracting including development of product pricing and utilizing financial modeling in making rate decisions
- Proven experience in managing teams and leading personnel
- Knowledge of Medicare and Medicaid regulations
- In-depth knowledge of Medicare Resource Based Relative Value System (RBRVS), DRGs, Inpatient Psychiatric Facility Prospective Payment System (IPF-PPS), bundled arrangements, and value-based programs
- Proven highly customer-focused, adaptable, and able to perform under pressure
- Proven capable of working independently with minimal supervision
- Demonstrate exceptional organizational skills and attention to detail
- Intermediate level of proficiency with MS Excel and other Microsoft Office applications
Preferred Qualifications:- Experience working for a Fortune 500 company
- Experience with behavioral health specialties and market analysis/trends
*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 - $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.
