Develops and manages healthcare provider networks by evaluating and negotiating contracts, analyzing network adequacy, managing reimbursement rates and unit-cost budgets, and ensuring appropriate provider specialty distribution. Builds relationships with hospitals, physicians, pharmacies, and ancillary providers while resolving complex network and contracting issues. Requires New York reimbursement knowledge, financial modeling, claims-processing familiarity, a driver’s license, and reliable transportation.
Requisition Number: 2389605
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.
The Network Contract Manager develops the provider network (physicians, hospitals, pharmacies, ancillary groups & facilities, etc.) 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. Network Contract Managers evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Responsibilities also include establishing and maintaining strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties.
Get ready for some significant challenge. This is an intense, fast-paced environment that can be demanding. In addition, there are some data challenges and unique problems that need to be solved related to gaps in the process.
Estimated 5-10% of travel within New York is required.
If you are commutable to the State of New York, Northeast Region of the US preferred, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
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:
Preferred Qualifications:
*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 $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.
UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.
The Network Contract Manager develops the provider network (physicians, hospitals, pharmacies, ancillary groups & facilities, etc.) 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. Network Contract Managers evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Responsibilities also include establishing and maintaining strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties.
Get ready for some significant challenge. This is an intense, fast-paced environment that can be demanding. In addition, there are some data challenges and unique problems that need to be solved related to gaps in the process.
Estimated 5-10% of travel within New York is required.
If you are commutable to the State of New York, Northeast Region of the US preferred, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
- Assess and interpret customer needs and requirements
- Identify solutions to non-standard requests and problems
- Solve moderately complex problems and/or conduct moderately complex research and analysis
- Work with minimal guidance; seek guidance on only the most complex tasks
- Translate concepts into practice
- Provide explanations and information for others on difficult issues
- Understand and manage to unit cost budgets, target setting, performance reporting and associated financial models
- Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management
- Evaluate and negotiate contracts in compliance with company templates, reimbursement structure standards and other key process controls
- Ensure that network composition includes an appropriate distribution of provider specialties
- Provide explanations and information to others on difficult issues
Coach, provide feedback and guide others
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 a network management-related role, such as contracting or provider services
- 2+ years of experience and understanding performing network adequacy analysis
- Intermediate level of knowledge and understanding of New York state and federal reimbursement methodologies
- Intermediate level of knowledge and understanding of fee schedules and utilizing financial models and analysis to develop rates with providers
- Intermediate level of knowledge of claims processing systems and guidelines
- Driver's License and access to a reliable transportation
Preferred Qualifications:
- Proven excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
- Proven solid interpersonal skills, establishing rapport and working well with others
- Proven solid customer service skills
*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 $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.
UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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