UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
UnitedHealthcare is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
When you work with UnitedHealthcare, what you do matters. It's that simple…and it's that challenging.
In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.
Key Responsibilities
- Accountable for all network development and management activities with ancillary providers in accordance with UnitedHealthcare standards and key process controls to achieve market/region/division/company objectives.
- Responsible for leading and implementing network strategy, financial analyses, and language/cost negotiations for a specific set of ancillary providers.
- Leads negotiations with ancillary providers.
- When applicable, work with and involve relevant stakeholders (regional and corporate network management, internal customers, network pricing, etc.) in negotiation decisions impacting legal or regulatory requirements, contract standards and cost targets.
- Develop and successfully perform to geography-specific unit cost targets.
- Monitor geography-specific unit cost performance and improve competitiveness, breadth, and stability of ancillary networks.
- Develop and successfully implement geography-specific unit cost improvement plans for ancillary, Tier 2 and 3 hospital, and/or large physician medical group networks.
- Determine network adequacy and fill ancillarynetwork gaps at geography-specific competitive rates in accordance with unit cost targets.
- Ensure integrity of ancillary networks with UnitedHealthcare policies and compliance with pertinent regulatory guidelines.
- Accountable for relevant components of provider relationship management, including leading Joint Operating Committee (JOC) meetings, as necessary, and provider outreach/communication.
- Promote use of electronic provider on-line self-service tools in order to support and achieve operational efficiency yielding reduced costs to serve the relationship.
- Perform and monitor activities related to the contract load process; engage appropriate service organization for claims resolution; ARO; EDI; provider service/performance issues; and provider appeals.
- Provide advice/guidance/recommendations to senior management regarding health care costs; cost savings opportunities; best practices; provider performance issues; and network expansion.
- Maintain highest personal/professional integrity and enforce Principles of Integrity and Compliance.
Regardless of your role at UnitedHealthcare, the support you feel all around you will enable you to do what you do with energy, integrity, and confidence. So take the first step in what is sure to be a fast paced and highly diversified career.
Four to eight years in a network development/contract management role, such as contracting, purchasing, etc.
Bachelor's degree in business, health care management, or related field.
Significant additional experience may be considered in lieu of a Bachelors degree, at the discretion of the hiring manager.
High degree of proficiency in utilizing and interpreting financial models and network adequacy analyses.
Strong knowledge of RBRVS, Ambulatory Surgery Center groupers, per diem, per case, DRG and APC reimbursement methodologies and clear understanding of Medicare and UnitedHealthcare claims processing guidelines.
Experience applying pricing, financial analyses, hospital bill audit results and contract standards to the development of Requests for Proposals and negotiation strategies.
Problem solving skills:
Systematically analyze complex problems
Draw relevant conclusions
Successfully devise/implement appropriate solutions
Excellent verbal and written communication skills:
Speak clearly and concisely
Conveying complex or technical information in a manner that others can understand
Understand and interpret complex information from others
Speak in both individual and group settings
Negotiation skills
Implementation/influencing skills
Possesses good interpersonal skills:
Establishing rapport and working well with others
Lead by example
Performance Driven:
Achieves stretch unit cost objectives and ensures that all Ancillary, Tier 2 and 3 Hospital, and/or large Physician group contracts are in compliance with UnitedHealthcare contract template standards.
High-Velocity Change:
Drives network initiatives to achieve targeted growth, IOI, and operating targets to better position UnitedHealthcare's networks competitively.
Operating Efficiency:
Implements and operates an Ancillary, Tier 2 and 3 Hospital, and/or large Physician group network that are in compliance with UnitedHealthcare process controls and standards.
Facilitates reduction in total cost to meet customer and business partner expectations of Ancillary providers, Tier 2 and 3 Hospitals, and/or large Physician groups.
Multi-task, shifting back and forth effectively among multiple activities.
Top-Performing Employees Are Our Greatest Asset:
Fosters a competitive environment internally and serves as a role model/mentor to other employees seeking career development in network management.
Cutting Edge:
Consistently demonstrates ability to act and react swiftly to network challenges.
Build Value to Customers: Develops and operates a competitive, stable Ancillary, Tier 2 and 3 Hospital, and/or large Physician group networks with broad access that meets stretch unit cost objectives
Provide customers products at predictable/affordable cost
Accountability through Matrix Management: Works collaboratively across functional areas to ensure superior operational efficiency of Ancillary, Tier 2 and 3 Hospital, and/or large Physician group networks.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
