Remote Provider Network Architect

UnitedHealthcare; Houston (TX); Remote; USD 73,000 - 130,000; Full time

Job summary

UnitedHealthcare seeks a Network Contract Manager to develop the provider network, negotiate contracts, and support cost management objectives to deliver affordable, high-quality care.

You’ll establish and maintain relationships with physicians, hospitals, and other providers, ensure a geographically competitive network, and guide network composition to meet performance targets while working remotely from anywhere in the U.S.

Qualifications

• 3+ years of experience in a network management-related role, such as contracting or provider services.
• 3+ years of experience in fee schedule development using actuarial models.
• 3+ years of experience in performing network adequacy analysis.
• 2+ years of experience using financial models and analysis to negotiate rates with providers.
• In-depth knowledge of Medicare Resource Based Relative Value System (RBRVS).
• Intermediate level of knowledge of claims processing systems and guidelines.

Responsibilities

• Manage 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 and reimbursement structure standards.
• Ensure that network composition includes an appropriate distribution of provider specialties.
• Provide explanations and information to others on difficult issues.

Skills

Network management

Contracting

Actuarial models

Network adequacy analysis

Provider rate negotiation

RBRVS knowledge

Claims processing knowledge

Education

Undergraduate degree

Job description

UnitedHealthcare seeks a Network Contract Manager to develop the provider network, negotiate contracts, and support cost management objectives to deliver affordable, high-quality care.

You’ll establish and maintain relationships with physicians, hospitals, and other providers, ensure a geographically competitive network, and guide network composition to meet performance targets while working remotely from anywhere in the U.S.