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Job Details

Network Contract Manager - Tyler, TX


Nurse Manager


Tyler, Texas, United States

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 Network Contract Manager develops the provider network by establishing and maintaining a solid business relationships with Primary Care Physician, Specialty Physicians, or Ancillary providers and ensures the network composition includes an appropriate distribution of provider specialties.

Primary Responsibilities:

  • Develop/Negotiate/Support Terms of Agreement with providers
  • Balance financial and operational impact of contracts to providers, members, UHN, and different customer groups when developing and/or negotiating contract terms
  • Demonstrate understanding of contract policies to ensure compliance and consistent contracting across the enterprise
  • Demonstrate understanding of contract language and terms of the agreement to ensure that financial/operational impact and legal implications are aligned with business objectives
  • Demonstrate understanding of contractual financial and non-financial terms
  • Communicate proposed contractual terms with a provider and negotiate a mutually acceptable agreement
  • Seek information from relevant sources (e.g., COB data; publications; government agencies; providers; provider trade associations) to understand market intelligence information
  • Evaluate current contract performance to identify potential remediation opportunities and/or cost savings
  • Demonstrate understanding of competitor landscape within the market (e.g., rates; market share; products; provider networks; market intelligence; GeoAccess)
  • Demonstrate understanding of provider termination process
  • Manage Provider Relationships
  • Explain the organization's direction and strategy to internal partners and providers to justify methodologies, processes, policies, and procedures
  • Demonstrate benefits of applicable reimbursement methodology to internal partners and providers
  • Identify and gather information regarding provider issues to develop and/or implement a strategy to resolve the matter, keep the manager informed of progress, or escalate the issue to the appropriate internal business partner
  • Represent department in external meetings (e.g. physician groups; facilities) to gather relevant information, recommend solutions, execute on deliverables as assigned, and explain results/decision/activities
  • Report back information from provider meetings to the applicable stakeholder (e.g., manager; business partner) to determine appropriate action)
  • Conduct high-level meetings with Executive Staff and Providers Virtual or In-person
  • Coach, provide feedback and guide others internal and external
  • Generally work is self-directed and not prescribed
  • Attend bi-monthly provider dinners and/or semi-annual provider summits

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:

  • Undergrad degree or equivalent work experience
  • 3+ years of experience in a network management-related role, provider relations, or account management- such as contracting provider services
  • 3+ years of experience in fee schedule development using actuarial models
  • 3+ years of experience using financial models and analysis to negotiate rates with providers
  • 3+ years of experience in performing network adequacy analysis
  • Intermediate level of knowledge of claims processing systems and guidelines
  • Intermediate knowledge of Microsoft Word and Excel (pivot tables, formulas etc.)
  • Ability to Travel up to 75% regionally
  • 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:

  • Bachelor’s degree
  • Value-Based Care experience with the understanding of delegation of risk and managed care
  • In-depth knowledge of Medicare Resource-Based Relative Value System (RBRVS)
  • Experience managing value-based managed care relationships and accountable care organizations
  • Experience in health plan contracting with shared saving agreements
  • Excellent presentation skills

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.