Network Program Consultant - Remote
UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)
What makes your career greater with UnitedHealth Group? Growth opportunities among the variety of product lines and making an impact on the healthcare system ensures it will always be challenging and exciting. The Network Contract Manager supports development of the provider network (hospitals, ancillary groups and facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners. Network Contract Managers interpret market specific reimbursement methodologies to develop and maintain contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Responsibilities also include establishing and maintaining strong business relationships with applicable stake holders through processes which deliver transparent and predictable pricing strategies for C&S products. This ensures UHN’s ability to build superior provider networks with minimal business risks.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
- Develop and maintain facility and professional payment appendix language to support government program reimbursement strategies
- Understand government programs reimbursement strategies for various provider types
- Research and collaborate with appropriate business owners to support market needs
- Coordinate with business partners such as system configuration and affordability teams and other departments / segments to implement reimbursement and pricing strategies
- Respond to requests to support the implementation of successful contracting strategies
- Conduct training on standard payment appendices
- Educate business partners on reimbursement strategies supporting government programs
- Evaluate requests and issues raised from the regional Health Plan, Network Management and HCE Network Pricing staff for potential revisions / enhancements to the standard payment appendices and market payment appendices
- Identify solutions to non-standard requests and problems
- Solve moderately complex problems and / or conduct moderately complex analyses
- Work with minimal guidance; seek guidance on only the most complex tasks
- Translate concepts into practice
- Provide explanations and information to others on difficult issues
- Coach, provide feedback, and guide others
- Act as a resource for others with less experience
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.
- Bachelor’s degree in business, health care management or related field, OR equivalent experience
- 4+ years of experience in a health care network management-related role, such as contracting or provider services
- Knowledge and proficiency in health care industry and facility contracting process
- Working knowledge of Medicaid reimbursement methodologies (such as DRG, MS-DRG, APC, Prospective Payment System (PPS), per case, per visit, per unit, per unit via fee schedule, OPG, MSPS)
- 3+ years of experience in fee schedule development using actuarial models
- 3+ years of experience utilizing financial models and analysis in negotiating rates with providers
- In-depth knowledge of Medicare reimbursement methodologies, i.e. Resource Based Relative Value System (RBRVS)
- In-depth knowledge of MSPS and non-standard reimbursement
- Intermediate level of knowledge of claims processing systems and guidelines
- Experience using CSP Facets, COSMOS and Emptoris
- Excellent customer service skills
- Excellent verbal and written communication skills (ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others)
- Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
- Ability to manage multiple high priority projects simultaneously
- Ability to assess and interpret customer needs and requirements
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 UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)
Colorado, Connecticut, Nevada, or New York City Residents Only: The salary range for Colorado residents is $66,100 to $118,300. The salary range for Connecticut/Nevada/New York City residents is $72,800 to $129,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.