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. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
This self-directed role with OptumHealth will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. You will manage contracts, cost trend, relationships and network growth/strategy for Optum's Centers of Excellence provider networks (transplant, cancer, congenital heart disease and VAD) through provider negotiations with large academic hospitals and health systems. This position is responsible for executing on network strategies to meet client and sales goals; contracting competitive rates; evolving the payment methodology to align with the line of business; and managing provider relationships.
If you are located in South Carolina area, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
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Analyze and evaluate payment appendices to strategize options for various contracting approaches and methodologies
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Evaluate market rates and provider performance (e.g., billing patterns; referral patterns; quality and effectiveness) in order to establish provider rates and negotiation strategies
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Explain the organization's direction and strategy to providers in order to justify methodologies, processes, policies, and procedures
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Input contract projections accurately into appropriate tools and analyze financial impact of provider contracts to achieve company goals
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Communicate proposed contractual terms with provider and negotiate mutually acceptable agreement
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Establish and manage relationships with providers to navigate operational, legal, financial and clinical matters
In this role, you will need to be able to thrive in a demanding, intense, fast-paced environment. In addition, you'll be driving some complex negotiations while striving to ensure accuracy.
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:
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5+ years of experience in a network management-related role handling complex network providers with accountability for business results
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5+ years of experience in the health care industry
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2+ years of experience with provider contracting including development of product pricing and utilizing financial modeling in making rate decisions
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In-depth knowledge of Medicare Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.
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Knowledge of Medicare and Medicaid regulations
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Intermediate level of proficiency with MS Excel and other Microsoft Office applications
Preferred Qualification:
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Experience with in vivo gene therapy COE networks
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.
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.
UnitedHealth Group is 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 is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
