Sr Network Contract Manager - Remote

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Position in this function is responsible for provider recruitment and negotiating provider agreements for UnitedHealthcare’s Empire Plan. Develops the provider network 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 Physicians and ensures the network composition includes an appropriate distribution of provider specialties. The Sr. Network Contract Manager will also be responsible for tracking and trending out of network recruitment activity, cost savings and making recommendations on potential contracting opportunities to support provider network adequacy.

If you are located in New York City; Albany, New York, upstate New York, downstate, New York and northern New Jersey, Kingston, New York, or Islandia, New York, you will have the flexibility to work remotely* as you take on some tough challenges

Primary Responsibilities:

• Forecasts and plans resource requirements
• Initiate contact with providers regarding proposals, to overcome rate objections and utilize effective and efficient negotiation skills to obtain appropriate reimbursement rates
• Explain the organization's direction and strategy to internal partners and providers in order to justify methodologies, processes, policies, and procedures
• Anticipates customer needs and proactively develops solutions to meet them
• May lead functional or segment teams or projects
• Job Scope and Guidelines
  • Initiate contact with providers regarding proposals, to overcome rate objections and utilize effective and efficient negotiation skills to obtain appropriate reimbursement rates
  • Develop and build provider relationships to facilitate current and future provider agreements
  • Anticipates customer needs and proactively develops solutions to meet them
  • Serves as a key resource on complex and/or critical issues
  • Forecasts and plans resource requirements
  • May lead functional or segment teams or projects
• Communicate proposed contractual terms with provider and negotiate mutually acceptable agreement
• Utilize appropriate contract management systems (e.g., CLM; Contract Attachment Repository) to author and execute contracts and to access supplemental contractual documents
• Analyze UCRT associated with products, markets, and/or providers to assess performance against budget
• Sought out as an expert
• Develop and build provider relationships to facilitate current and future provider agreements
• Identify and gather information regarding provider issues to develop and/or implement strategy to resolve matter, keep manager informed of progress, or escalate issue to appropriate internal business partner
• Manage Provider Relationships
• General Job Profile
  • Reviews the work of others
  • Develops innovative approaches
  • Sought out as an expert
  • Serves as a leader/mentor
• Interact and consult with Network Pricing team to evaluate different financial arrangements and to identify and recommend
• Communicate contractual and/or operational performance to providers to ensure compliance with contractual terms and protocols
• Functional Competencies - Develop/Negotiate/Support Terms of Agreement with Providers
  • Interact and consult with Network Pricing team to evaluate different financial arrangements and to identify and recommend
  • Utilize appropriate contract management systems (e.g., CLM; Contract Attachment Repository) to author and execute contracts and to access supplemental contractual documents
  • Communicate proposed contractual terms with provider and negotiate mutually acceptable agreement
  • Updates appropriate source systems within designated timeframes to ensure that requests are closed out timely
  • Manage Provider Relationships
  • Explain the organization's direction and strategy to internal partners and providers in order to justify methodologies, processes, policies, and procedures
  • Identify and gather information regarding provider issues to develop and/or implement strategy to resolve matter, keep manager informed of progress, or escalate issue to appropriate internal business partner
  • Communicate contractual and/or operational performance to providers to ensure compliance with contractual terms and protocols
    
• Demonstrate understanding of and utilize applicable financial tools (e.g., PPM; HCE's RVU/Unit tool) and reports (e.g., internal financial models; external reports) to evaluate performance of current contracts
• Updates appropriate source systems within designated timeframes to ensure that requests are closed out timely
• Serves as a key resource on complex and/or critical issues
• Demonstrate understanding of contract language to assess financial and operational impact and legal implications of requested contract changes
• Serves as a leader/mentor
• Reviews the work of others
• Functional Competencies - Evaluate/Analyze Current Contract and Market Performance
  • Analyze UCRT associated with products, markets, and/or providers to assess performance against budget
  • Demonstrate understanding of and utilize applicable financial tools (e.g., PPM; HCE's RVU/Unit tool) and reports (e.g., internal financial models; external 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 competitor landscape within the market (e.g., rates; market share; product; provider networks; market intelligence; GeoAccess)
• Demonstrate understanding of competitor landscape within the market (e.g., rates; market share; product; provider networks; market intelligence; GeoAccess)
• Develops innovative approaches

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:

• 2+ years of experience with payment methodologies (Ex. APR DRG, MS DRG, APCs, RBRVS, Per Diems)
• 2+ years of proficiency in Excel & Word
• Bachelor’s Degree or 4 years of equivalent experience
• 4+ years of experience working within one or more of the following areas: Contract Management, Managed Care, and Network Management
• 2+ years of experience negotiating rates with providers using financial tools and reports
• 2+ years of experience managing assignments within tight deadlines
• Ability to travel up to 25%

Preferred Qualifications:

• Experience in a matrixed environment managing key stakeholders
• Experience in project management
• Proficiency in PowerPoint
• Experience in Root Cause resolution
• Proven critical thinking

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.(sm)

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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.