- Requisition number:
- 2356798
- Job category:
- Network Contracting & Pricing At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start
- Caring. Connecting. Growing together.
- You've been building towards this.
We've been building towards you. The health care system needs are evolving at a fast clip and innovators like UnitedHealth Group are playing a lead role. New models of care and new networks of providers are emerging now to better serve patients and communities. Here's where you come in. As a director within our network contracting team, you'll guide the development and support of provider networks as well as unit cost management activities through financial and network pricing modeling, analysis, and reporting. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 6 leader.
Primary Responsibilities:
- + Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management + Develop and execute strategies for a function or discipline that span a large business unit or multiple markets/sites + Apply network configuration and incentive-based payment models as appropriate to improve quality and efficiency + Direct others to resolve business problems that affect multiple functions or disciplines + Direct work that impacts entire functions and/or customer accounts (internal or external) This challenging, high-profile role will put your skills and experience to the test daily.
You'll be charged with leading the efforts to achieve synergy targets through contracting with our network providers. In addition, you will lead the high-performing team that supports the UnitedHealthcare client relationship for network/provider management. 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. Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties.
- Employees in jobs labeled with 'SCA' must support a government Service Contract Act (SCA) agreement.
+ Provides leadership to and is accountable for the performance and results through multiple layers of management and senior level professional staff + Impact of work is most often at the regional (e.g. multi-state) level, or is responsible for a major portion of a business segment, functional area or line of business 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:
- + 10+ years of management experience in a network management-related role handling complex network providers with accountability for business results + 8+ years of experience in developing of product pricing and utilizing financial modeling in making rate decisions in the health care industry + 5+ years of experience developing and managing a medical cost and administrative budget + 5+ years of experience with provider contracting with large health systems (hospitals, physician groups, ancillary services) Accountable Care Incentive Agreements, Large Physician Groups, Large hospital systems + Expert level of knowledge of Medicare Resource Based Relative Value System (RBRVS), Diagnosis Related Groups, Ambulatory Surgery Center Groupers, capitation, delegated claims/um, case rate methodology, outlier methodology, etc.
+ Driver's License and access to a reliable transportation Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $159,300 to $273,200 annually based on full-time employment. We comply with all minimum wage laws as applicable. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._
