This self-directed role is responsible for the development, contracting, and ongoing management of OptumHealth's Cell and Gene Therapy (CGT) Centers of Excellence (COE) provider network, including leading complex provider negotiations to establish single case and network agreements with academic medical centers, large health systems, community-based oncology and hematology practices, and specialty pharmacies across all lines of business. This position requires a high degree of independence, advanced provider contracting experience, solid financial acumen, and the ability to manage complex provider relationships and negotiations across a highly matrixed organization.
In this role, you will execute network strategies to meet client and sales objectives; conduct financial and rate modeling to deliver competitive reimbursement arrangements; advance payment methodologies to align with the line of business; conduct coding and reimbursement research for emerging CGT products; support the resolution of case setup, operational, and contract administration issues; and establish and maintain solid provider relationships to support network performance and operational objectives.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:- Evaluate and negotiate contracts in accordance with company contract templates, reimbursement methodologies, compliance requirements, and other key process controls
- Analyze and evaluate bundled payment arrangements and high-cost drug reimbursement methodologies related to Cell and Gene Therapy (CGT) services
- Leverage multiple data sources to analyze market rates, provider performance metrics, and utilization trends to support reimbursement strategies and contract negotiations
- Communicate organizational strategy, contracting methodologies, reimbursement approaches, policies, and operational requirements to providers while negotiating mutually acceptable agreements
- Assess the financial impact of contract terms and reimbursement arrangements to support business objectives and network strategy
- Manage provider relationships and navigate operational, legal, financial, and clinical matters
- Review contract redlines and develop responses that align with applicable legal, financial, regulatory, and operational requirements
- Collaborate with provider executive leadership, internal stakeholders, and cross-functional teams across a highly matrixed organization to resolve issues and support network objectives
Key Competencies:- Advanced provider contracting and network management experience
- Solid analytical, financial, and problem-solving skills
- Ability to work independently with minimal direction
- Excellent prioritization, organization, and attention to detail
- Sound judgment and decision-making capabilities
- Solid relationship-building and collaboration skills
- Ability to manage complex negotiations and competing priorities in a fast-paced environment
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:- 4+ years of experience in provider network management or contracting role managing complex provider relationships and negotiations with accountability for business results
- 2+ years of experience in provider contracting, including the development of reimbursement methodologies and product pricing, and the use of financial modeling to support rate-setting decisions
- Knowledge of bundled payment and case rate methodologies, Medicare Resource-Based Relative Value Scale (RBRVS), Diagnosis-Related Groups (DRGs), and related reimbursement methodologies
- Knowledge of Medicare and Medicaid regulations
- Intermediate to advanced level of proficiency in Microsoft Excel
Preferred Qualification:- Experience with high-cost cell and gene therapies, organ transplants, or cancer specialties
*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.
