IT Job Pro

Most Popular Tech Job site – Find Jobs || Post Jobs

Senior Hospital / Facility Provider Network Contract Manager – Cypress, CA

Cypress, CA UnitedHealth Group

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life’s best work.(sm)

 

The Senior Network Contract Manager develops the provider network (physicians, hospitals, pharmacies, ancillary groups & 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. Senior Network Contract Managers evaluate and negotiate 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 Hospital, Physician, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties.


 

We are looking for an experienced contract negotiator who has a vast knowledge base of pricing mechanisms, contract negotiation strategy for capitation and fee for service reimbursement methodology for commercial, Medicare and Medicaid lines of business. Candidate will be handling all negotiations and network management functions for hospitals/medical groups in Southern California.


 

Primary Responsibilities:


  • Independently develop contract negotiation strategies to meet all business objectives for Commercial, Medicare and Medi-Cal Lines of Business

  • Lead contract negotiations on all hospitals and medical groups for all assigned San Diego providers

  • Collaborate with other departments within UHC to achieve favorable outcomes (finance, pricing, legal…etc.)

  • Cultivate relationships and partnerships with assigned providers in San Diego

  • Serve as the primary point of contact for any contract related matters

  • Willingness to assist and mentor others on the team

  • Oversee contract implementation for all lines of business

  • Anticipate customer needs and proactively develop solutions to meet them

  • Serve as a key resource on complex and / or critical issues

  • Solve complex problems and develop innovative solutions

  • Perform complex conceptual analyses

  • Review work performed by others and provide recommendations for improvement

  • Forecast and plan resource requirements

  • Authorize deviations from standards

  • May lead functional or segment teams or projects

  • Provide explanations and information to others on the most complex issues

  • Motivate and inspire other team members


Required Qualifications:


  • Bachelor’s degree or equivalent experience

  • 6+ years of experience in a network management – related role handling complex network contract negotiations, specifically with hospitals and medical groups

  • Ability to utilize financial models and analysis in negotiating rates and reimbursement methodologies with providers

  • 3+ years of experience working with Capitation reimbursement methodologies

  • 3+ years of experience working with Fee for Service reimbursement methodologies

  • Familiarity with Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), MS-DRGs, Ambulatory Surgery Center Groupers, etc.

  • Ability to travel regionally approximately 25% of the time

  • Proficiency with MS Outlook, Word, Excel

 


Careers with UnitedHealthcare. Let’s talk about opportunity. Start with a Fortune 6 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)


 

 

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.


 

Job Keywords: contract manager, contractor, healthcare contracting, provider service, relations, negotiator, negotiations, Cypress, CA, California

To apply for this job please visit itjobpro.com.