- 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
- Influence and/or provide input to forecasting and planning activities
- This role is all about challenge and relationships. You'll partner with CEO's from various medical groups as we work on building effective relationships with providers in the market
- Engage and contract with independent physicians and provider groups to join theMid-Atlantic states ( GA, TN, SC or VA)RBE
- Develop and present PowerPoint presentations, negotiate, execute and maintain contracts and financial arrangements with independent physicians, hospitals, ancillary providers, independent practice associations (IPA's), and large provider groups
- Create solid relationships with potential network participants to build and grow the RBE business
- Facilitate external leadership meetings to drive strategic alignment and execution of network goals
- Assist hand-off to operational team for implementation of population health infrastructure and core programs by working collaboratively with multi-disciplinary team (IT, Clinical Operations, Quality, Risk Adjustment, and Provider Engagement)
- Identify and problem solve on a day-to-day basis to sustain relationships and ensure low provider network abrasion and attrition
- Use knowledge of negotiating entities to improve and enable competitive advantage in network contracting process
- Coordinate contract implementation and education to enhance quality and cost effectiveness
- Assisting in pre and post contract implementation audits to ensure provisions meet the intent of the contract
- 5+ years of experience in a network management-related role handling complex network providers with accountability for business results
- 2+ years of experience in provider network contracting in one of the Mid-Atlantic States listed
- Experience developing and presenting contextually rich and visually compelling presentations to clearly communicate complex concepts
- Experience collaborating to successfully activate team members and senior leadership to support IPA participant operational execution
- Knowledge of Medicare Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.
- Advanced knowledge of Microsoft PowerPoint; proficiency in Microsoft Excel and Word
- Understanding of healthcare value-based concepts, Medicare payment methodology, rates, and fee for service reimbursement methodologies across various specialties and facilities
- Based in one of the Mid-Atlantic states ( GA, TN, SC, NC or VA) with the ability to travel to provider offices (expected travel requirement 25- 50% local travel)
- 4+ years of fee-for-service/ACO/value-based care contracting or managed care experience at an integrated delivery system, population health services company or health insurance plan+
- Experience in external facing contract negotiation & Medicare Advantage network build
- Experience in understanding of Medical Loss Ratio (MLR) and capitated downstream arrangements
- Basic understanding of Healthcare financial pro formas and P&L development across network of providers
- Proven organization skills with an ability to multitask across projects in a variety of subject matter areas and manage up to ensure milestones are met
- Willingness to be a thought partner with other members of the Population Health team
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Network Development Manager - Chattanooga, United States - UnitedHealth Group
Description
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to startCaring. Connecting. Growing together.
The health care system needs to evolve even further than it has and it has to do so at a lightning fast pace. New models of care and networks of providers are emerging now to better serve patients and communities. And at UnitedHealth Group, we are playing a lead role. Here's where you come in. 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. In return, you'll discover the impact you want and the resources, backing and opportunities that you'd expect from a Fortune 5 leader.
Currently, Optum Health employs physicians inside its medical group assets and also runs a large risk-bearing entity (RBE) with global risk contracts covering over , dual-eligible MA members across several states. The leadership is focused on aggressively expanding owned-clinic assets, contracted physician network, and the membership assigned to the RBE in the region. The vision is to build a regional, integrated care delivery system that can accept pre-payment (capitation) and full accountability for patient members across multiple payers and multiple segments (e.g., MA and commercial). To do this, Mid Atlantic will pursue strategic growth and development opportunities across the full ambulatory care delivery spectrum, including physician offices, ambulatory surgery centers, home care, behavioral health, post-acute care and digital care assets. The region also will focus on membership growth by partnering upstream with leading MA and commercial plans through value-based contracts. Mid Atlantic is committed to building and a market-leading value proposition of high quality, high value care delivery for all patient members.
The primary focus of the Manager of Network Development is to engage independent physicians and build relationships in order to execute managed care agreements for participation in the Optum Health Network RBE. This directly contracted network is the cornerstone for RBE growth across the region for all current and future capitation contracts. The Manager will play a lead role in relationship development and facilitate agreement execution and maintenance of the contracted network with the ultimate goal of increasing the number of participating physicians and at-risk Medicare members in the Mid-Atlantic states ( GA, TN, SC, NC or VA) RBE. In this capacity, the role will collaborate closely with cross functional team leads in the region (e.g., Market Operations, Data Analytics, IT/Analytics, Finance, and Executive). The position requires strategic and critical thinking, negotiating skills, and the "hands-on" ability to get things done in the business operation. The position offers significant professional growth opportunity and the opportunity to participate in a highly innovative network build that integrates finance and healthcare delivery under total cost of care contracts throughout the region.
If you are based in of these states: GA, VA, NC, SC, TN, 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.
Years of post-high school education can be substituted/is equivalent to years of experience
Required Qualifications:
Preferred Qualifications:
*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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
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