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UnitedHealth Group

Health Plan Contracting Specialist -Hybrid Ontario, CA (111023656)

Equipment/Technology Specialist

Equipment and Facilities Specialist

Yearly

No

Ontario, California, United States

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

You get it. Everyone gets it. The health care system needs to evolve even further than it has and it has to do so quickly. New models of care and new networks of providers are emerging now to better serve patients and communities. And leaders like UnitedHealth Group are playing a lead role. Here's where you come in. As member of our Payor Contracting team, you'll help implement and support Health Plan contracting and guide contract management activities through contract reviews, contract interpretation, analysis, and reporting. As you do, you'll discover the impact you want and the resources, backing, and opportunities that you'd expect from a Fortune 5 leader.

Standard Hours: Mon-Fri from 8:00am-5:00pm. No nights, weekends or holidays

Primary Responsibilities:

  • Assist in operationalizing contracts from contracting through implementation leveraging standardized tools and quality processes end to end
  • Defined point of contact for Payor Contracting and Payor Relations regarding contract administration
  • Maintains contracts, including making changes and updates using various systems review contract language, compare and identify changes from current language
  • Loads, maintains, and updates the appropriate databases and departmental tools with statuses such as contract database (Legato), intranet (MyNAMM) departmental information, Health Plan Web Links, etc.
  • Handles internal and external communication relating to contract documents, updates and issues
  • Coordinate receipt and processing for all payor contracts, delegation agreements, memorandums of understanding (MOUs), letters of agreement (LOAs), termination notices, extension letters, etc.
  • Manage and coordinate JOC/JOM meetings with payers
  • Internal network liaison for Claims, Configuration, Medical Management, Provider Contracting and Finance
  • Perform Plan to Plan filings with the California DMHC
  • Other duties as assigned

Get ready for a high impact role. You'll be tasked with working in conjunction with our national clinics and hospitals to manage, collect, and analyze provider data, updating and loading provider data, and resolving any escalated issues with the clients. 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.


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:

  • High School Diploma or GED
  • 2 + years of experience in a health plan/payer contracting role
  • 2+ years of experience in fee schedule development
  • 2+ years of experience using analysis to negotiate rates with payers
  • Experience in interpretation of the division of financial responsibility
  • Experience in contract interpretation and document review, and concepts of managed care and capitation
  • Knowledge of Commercial and Medicare Advantage capitation
  • Intermediate level of knowledge of claims processing systems and guidelines
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • Undergraduate degree
  • Experience in performing network adequacy analysis
  • Experience working in contract database Legato


To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.


Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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