Market Director - West Florida, Tampa and Fort Myers
Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)
The Market Director is responsible for managing and negotiating contracted reimbursement arrangements with medical groups, IPA’s, individual physicians and certain ancillary providers. This position will execute and oversee the performance of contracts with payors, physicians, and ancillary services, and resolve operational issues that may arise. In addition, the Market Director will evaluate health care data as it is used in the development, implementation and monitoring of contractual relationships and will work closely with the COO - Optum/WellMed to develop new business ventures and markets, and evaluate new business strategies to improve the effectiveness of the health plan.
The purpose of this position is to ensure there is an adequate network, provide ongoing tracking and monitoring of that network and act as a liaison to the health plan with the providers in the network. The Market Director acts as the business development director, evaluating business opportunities and developing strategies with the COO - Optum/WellMed to ensure health plan success.
This position will provide day-to-day provider contracting and provider relations, monitor and track the provider network and work with Health Plan Operations to ensure that network needs are met, and will work with providers to ensure ongoing contracting where needs are identified. Responsible for provider education, in conjunction with health plan Provider Relations, to ensure that providers are adequately educated and knowledgeable about the health plan, including delivery and education of the Provider Manual. The position works closely with the COO - Optum/WellMed and Medical Directors to identify new providers for the network.
- Maintains and updates, through negotiation, all contracts prior to expiration. Seeks to negotiate changes that reduce financial and legal risks to the organization
- Evaluates proposals for specialists, sub-capitated providers and some ancillary providers and recommends options based on costs, changes, services and needs of members
- Acts as a resource to other internal department on payor issues and assures accurate implementation of contracts in addition to working with other departments to assure that appropriate mechanisms are in place to operationalize contracts
- Works closely with COO - Optum/WellMed to evaluate operational processes and enhance business strategies to identify most effective operational processes and maximize success of the health plan
- Seeks to reduce final risk by using data comparisons in the development and implementation of managed care strategies (i.e. contract negotiations) and communicates the results of data analysis and strategic planning to various audiences
- Handles complex, difficult and/or routine provider inquires and/or problems and facilitates resolutions of provider issues, striving to ensure that favorable relationships are maintained
- Conducts in-service education programs to providers regarding WellMed policies and procedures, ensuring delivery within the first quarter following execution of contract
- Supervising and overseeing the performance of Contracting Specialists. Assists in the growth and development of associates by sharing special knowledge with others
- Makes recommendations regarding reimbursement strategies to the appropriate manager and seeks ways to improve job efficiency
- Takes ownership of the total work process and provides constructive information to minimize problems and increase customer satisfaction
- Ability and willingness to travel as determined by business needs
- This role operates on a Hybrid schedule with about 50% travel in the West Florida region (Tampa and Fort Myers)
- Performs all other related duties as assigned
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 a related field
- 5+ years of management experience
- 2+ years of managed care experience
- Ability and willingness to travel as determined by business need
- The ability and willingness to work onsite in an office environment on a Hybrid schedule
- 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
- Master’s degree in related field
- 8+ years of network development experience
- Experience in negotiating and implementing contractual arrangements
- Progressive experience in a supervisory or managerial capacity
- Working knowledge of health care reimbursement practices, utilization management requirements, claims handling procedures, health insurance benefit administration and risk-based reimbursement
- Solid analytical and/or statistical skills
- Excellent written and presentation skills and the ability to easily communicate to diverse audiences
- Ability to solve problems and deal with a variety of concrete variances in situations where limited standardization exists
- Ability to creatively exercise initiative, logic and sound judgment in the development of strategies and contractual relationships
- Ability to organize and prioritize
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.
USMD part of OptumCare is a multi-specialty group of hospital, clinics and physicians. USMD serves the Dallas-Fort Worth metropolitan area with more than 250 physicians and associate practitioners, and provides healthcare services to patients in more than 20 different specialties at its 2 hospitals, 4 cancer treatment centers and nearly 50 physician clinics, many of which are multi-specialty.
Careers with USMD. If you’re idea of a great day at work involves putting great new ideas to work, we should talk. Throughout the greater Dallas area, we’ve built an evolving, integrated health care model that brings primary care and specialist providers together to work in new and better ways. A thriving part of OptumCare and the UnitedHealth Group family of companies, our multi - specialty group of hospitals, clinics and providers features more than 250 physicians and associate practitioners. We provide health care services to patients in more than 20 different specialties at our two hospitals, four cancer treatment centers and nearly 50 physician clinics. Join us and start doing 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.