Network Contracts Manager - Ontario, CA

Company: UnitedHealth Group
Location: Ontario
Posted on: March 18, 2023

Job Description:

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)It's a big step forward when you realize that you've earned the trust to lead a team. Now, let's determine just how big that step can be. Take on this managerial role with UnitedHealth Group and you'll be part of a team that's reshaping how provider networks evolve and how health care works better for millions. As a manager within our network contracting team, you'll 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, you'll discover the impact you want and the resources, backing and opportunities that you'd expect from a Fortune 6 leader.If you are located in Ontario, CA, you will have the flexibility to work from home--and the office--at least 1 - 2 days per week--in this hybrid role* as you take on some tough challenges.--Primary Responsibilities:

• 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 assignedYou'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 of experience in a network management related role, such as contracting/recruiting or provider services
  • 2+ years of experience using financial models and analysis to negotiate rates with providers
  • Proficiency with Microsoft Office applications to include Word, Excel, Visio, PowerPoint, Smartsheet, SharePoint, Microsoft Teams, and Outlook
  • Ability to travel 10%Preferred Qualifications:
    • 3+ years of experience in fee schedule development using actuarial models
    • 3+ years of experience using financial models and analysis to negotiate rates with providers
    • 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 environmentCareers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.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.

Keywords: UnitedHealth Group, Ontario , Network Contracts Manager - Ontario, CA, Executive , Ontario, California