Network Contract Manager
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| Reference |
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| Job Type |
Full-time |
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| Job Status |
Sourcing |
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| Date Posted |
Wednesday, 24 September 2008 |
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| Location |
Philadelphia |
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| Duration |
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| Company Information |
UnitedHealthcare
Philadelphia,
PA
Website: http://www.unitedhealthgroup.com
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| Job Description |
UnitedHealthcare, a UnitedHealth Group company, provides network-based health and well-being benefits and services for employers and consumers nationwide. We use our strength, diversity and innovation to improve the lives of the more than 18 million people who receive our unique products and services. And our endless pursuit for excellence in everything we do extends to your career as well. Join us today for an inspired and purposeful mix of professional growth opportunities and personal rewards. Job Description: To support the Director in leading the Network Management staff of a large health plan with a complex network in achieving goals set for the department, both financial and non-financial, and ensuring that the staff is adequately prepared to perform their day to day accountabilities. Primary Responsibilities: - Provide management support to the Director of Network Management
- Manage and develop Network Management staff resources
- Participate in the development of and has direct accountability for execution of specified health plan network strategies
- Assist Director in oversight of the health plan's medical cost per unit trend budget by monitoring and document activities related to specific strategies.
- Assist Director in managing the relationship with AmeriChoice of Pennsylvania as well as with one or more of UnitedHealth Group's affiliated companies, including Uniprise, UBH, UHN, URN, Optum, Extended Markets, etc., as delegated by Director
- Establish and maintain strong collaborative relationships with UnitedHealth Networks leadership and regional Network Management leadership
- Act as Network Management liaison to other operational areas within the health plan
- Assist Director in creation and monitoring of specific initiatives for the health plan's Medical Expense Action Plan related to cost per unit issues as assigned by the Director; participate in the creation of the annual cost per unit budget and any interim re-forecasting on a monthly basis
- Represent Network Management at local and regional meetings when requested
- Monitor and influence claim resolution processes performed by Uniprise
- Prepare, analyze, review and projects financial / systems impacts of various negotiation strategies.
- Monitor ongoing provider performance for changes in cost and utilization trends.
- Ensure that contracts are executed, loaded, and audited accurately and timely.
- Develop and analyze provider proposals to support contracting initiatives.
- Develop and maintain professional working relationships with hospital, ancillary and physicians providers according to the Relationship Management Guidelines
Negotiate individual contracts with hospitals, ancillary and large physician group provider
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. |
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| Qualifications |
• Ideal candidate will demonstrate a broad-scope of financial, reimbursement, and contracting expertise
• A minimum of 3-5 years experience working in the hospital industry or working for a health insurer in a network management role handling complex network providers with accountability for business results is required
• Bachelors degree in business, health care management or related field, or equivalent experience
• Excellent knowledge of health care industry
• Strong negotiation skills; the ability to gain acceptance from others of a plan or idea and achieve a mutually beneficial outcome
• Ability to create and manage a medical cost and administrative budget, contribute to the development of product pricing and to interpret and take action on trend reporting
• Knowledge of Medicare and Medicaid reimbursement methodologies (Resource Based Relative Value System, DRG, Ambulatory Surgery Center Groupers, etc.)
• Extensive experience using Excel and working with data is preferred. Ability to utilize financial modeling and analysis in making rate decisions.
• In-depth knowledge of the contracting process
• Problem Solving skill; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
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| How to Apply |
Please apply on line at: www.unitedhealthgroup.com/careers
You can locate this position under requisition number 213405.
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