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Network Contract Consultant - Albuquerque, New Mexico

Company: UnitedHealth Group
Location: Albuquerque
Posted on: January 15, 2022

Job Description:

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)Network Contracting Consultant is responsible for jobs related to provider network contract negotiation and pricing to support the development of geographically competitive, broad access, stable provider network that is both affordable and predictable. Adheres to policies, procedures and regulations to ensure compliance and patient safety. Participation in Compliance and other important training is a condition of employment.Primary Responsibilities:

  • Develops the provider network (physicians, pharmacies, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for cost performance
  • Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls
  • Establishes and maintains solid business relationships with Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties
  • Balance financial and operational impact of contracts to providers, members, and different customer groups when developing and/or negotiating contract terms
  • Evaluate market rates and provider performance (e.g., billing patterns, referral patterns, quality and effectiveness) in order to establish provider rates and negotiation strategies
  • -Explain the organization's direction and strategy to internal partners and providers in order to justify methodologies, processes, policies, and procedures
  • Identify and gather information regarding provider issues in order to develop and/or implement strategy to resolve matter, keep manager informed of progress, or escalate issue to appropriate internal business partner
  • Represent department in external meetings (e.g., ancillary providers; physician groups; facilities) to gather relevant information, recommend solutions, execute on deliverables as assigned and explain results/decision/activities
  • Monitor and/or oversee provider financial performance to identify opportunities to improve performance and/or provider relationship
  • Educate providers on the organization's processes, policies, and procedures in order to ensure provider compliance and ease of administration
  • Monitor and/or oversee network performance and industry trends to identify opportunities to refine, develop, and/or implement market strategies
  • Other duties as assignedYou'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:
    • Bachelor's Degree in related field
    • Related education and experience may be substituted for one another on a year for year basis
    • 5+ years of -experience with network contracting in a managed care environment
    • Network Data Experience - contracts, rates, and configuration
    • Operations/claims experience
    • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliancePreferred Qualifications:
      • Demonstrate understanding of and utilize applicable financial tools (e.g., HPM, PPM, FAT, HCE's RVU/Unit tool) and reports (e.g., internal financial models, external reports) to develop rates
      • Utilize appropriate contract management systems (e.g., Emptoris, PEGA, Contract Attachment Repository) to author and execute contracts and to access supplemental contractual documents
      • Demonstrate understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changes
      • Demonstrate understanding of competitor landscape within the market (e.g., rates, market share, products, provider networks, market intelligence, GeoAccess)To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination 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 at OptumCare. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life's best work.(sm) Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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. -OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employmentJob Keywords: Network Contract Consultant, Albuquerque, New Mexico, NM

Keywords: UnitedHealth Group, Albuquerque , Network Contract Consultant - Albuquerque, New Mexico, Professions , Albuquerque, New Mexico

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