Senior Network Contract Manager – Remote

UnitedHealth Group; Los Angeles (CA); Remote; USD 92,000 - 164,000; Full time

Job summary

OptumHealth, part of UnitedHealth Group, seeks a self-directed professional to manage contracts, cost trends, relationships and network growth for Centers of Excellence through provider negotiations with major academic hospitals and health systems.

The role requires navigating complex contracting strategies and regulatory knowledge to achieve client and sales goals, while maintaining strong provider relationships. Remote work is allowed nationwide.

Qualifications

• 5 years of experience in a network management-related role handling complex network providers with accountability for business results.
• 5 years of experience in the health care industry.
• 2 years of experience with provider contracting including development of product pricing and utilizing financial modeling in making rate decisions.
• Knowledge of Medicare and Medicaid regulations.
• In-depth knowledge of Medicare RBRVS, DRGs, Ambulatory Surgery Center Groupers, etc.
• Intermediate level of proficiency with MS Excel and other Microsoft Office applications.
• Driver's License and access to reliable transportation.

Responsibilities

• Analyze and evaluate payment appendices to strategize contracting options.
• Evaluate market rates and provider performance to establish provider rates and negotiation strategies.
• Explain the organization’s direction and strategy to providers in order to justify methodologies, processes, policies, and procedures.
• Input contract projections accurately into appropriate tools and analyze financial impact of provider contracts to achieve company goals.
• Communicate proposed contractual terms with provider and negotiate mutually acceptable agreement.
• Establish and manage relationships with providers to navigate operational, legal, financial and clinical matters.

Skills

Network management

Healthcare industry knowledge

Financial modeling

Medicare/Medicaid regulations

RBRVS/DRGs knowledge

MS Excel proficiency

Tools

MS Excel

Job description

Requisition number: 2394887

Job category: Network Contracting & Pricing

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 in making healthcare work better for everyone through people-led, responsible AI while 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.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Analyze and evaluate payment appendices to strategize options for various contracting approaches and methodologies

• Evaluate market rates and provider performance (e.g., billing patterns; referral patterns; quality and effectiveness) in order to establish provider rates and negotiation strategies

• Explain the organization’s direction and strategy to providers in order to justify methodologies, processes, policies, and procedures

• Input contract projections accurately into appropriate tools and analyze financial impact of provider contracts to achieve company goals

• Communicate proposed contractual terms with provider and negotiate mutually acceptable agreement

• 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:

• 5 years of experience in a network management-related role handling complex network providers with accountability for business results

• 5 years of experience in the health care industry

• 2 years of experience with provider contracting including development of product pricing and utilizing financial modeling in making rate decisions

• Knowledge of Medicare and Medicaid regulations

• In-depth knowledge of Medicare Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.

• Intermediate level of proficiency with MS Excel and other Microsoft Office applications

• Driver's License and access to reliable transportation

Preferred Qualifications:

• Experience working for a Fortune 500 company

• Experience with high-cost cell and gene therapies, organ transplants, or cancer specialties

*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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.