Take on this VACCN (Veterans Affairs Community Care Network) Network Contract Manager role with UnitedHealth Group and you9ll be part of a team that9s reshaping how provider networks evolve and how health care works better for millions. You9ll guide the development and support of Provider Networks as well as unit cost management activities through financial and network pricing modeling, analysis, and reporting. As you do, you9ll discover the impact you want and the resources, backing and opportunities that you9d expect from a Fortune 5 leader.
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 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, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties.
If you are able to work Eastern (EST) Time zone and Central (CST) Time zone work hours, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:- Demonstrate understanding of VACCN program; and if applicable, products for different lines of business
- Evaluate current VACCN contract performance to identify potential remediation opportunities and/or cost savings
- Demonstrate understanding of and utilize applicable tools and reports to evaluate performance of current contracts
- Demonstrate understanding of contract language to assess financial and operational impact and legal implications of requested contract changes
- Demonstrate understanding of provider network landscape within the assigned territory
- Balance financial and operational impact of contracts to providers, members, UHN, VACCN and different customer groups, where applicable, when developing and/or negotiating contract terms
- Weigh financial and operational information to evaluate continued provider participation
- Demonstrate understanding of contract language and terms of agreement to ensure that financial/operational impact and legal implications are aligned with business objectives
- Utilize appropriate contract management systems to author and execute contracts and to access supplemental contractual documents
- Demonstrate understanding of submission tools to ensure accurate and timely contract configuration for customer groups
- Communicate proposed contractual terms with provider and negotiate mutually acceptable agreement
- Represent department in external meetings and take appropriate action
- Monitor and/or oversee provider performance to identify opportunities to improve
- Communicate contractual and/or operational performance to providers to ensure compliance with contractual terms and protocols
- Demonstrate understanding of provider termination process
You9ll 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 network management-related role, such as provider contracting or provider relations
- 3+ years of experience in working directly with providers on contract language and fee schedule negotiations
- 3+ years of experience using financial models and analysis to negotiate rates with providers
- 3+ years of experience in reviewing and acting upon network adequacy analysis to ensure compliance with customer requirements
- In-depth knowledge of Medicare and other industry-standard payment methodologies
- Intermediate level of knowledge of claims processes, including but not limited to claims submissions and adjudication systems and guidelines
- Proven solid communication skills
*All employees working remotely will be required to adhere to UnitedHealth Group9s 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, you9ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 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.
