If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Financial discipline and accountability count more today than ever. Which is why your performance and innovation will find a reception here like nowhere else as you help people live healthier lives while doing life's best work.(sm) This opportunity is a senior level consultative network contracting and operations management role within the Payer and Provider Contracting Strategy and Network Development Team. The qualified individual will build key partnerships with the Care Delivery Organizations, providers, hospitals, payers, and operational matrix partners focused on determining readiness, implementing, and operationalizing the terms of payer and provider agreements from fee for service (FFS) to delegated global risk agreements. Specifically, the Associate Director will use her/his strategic business acumen and proven leadership skills to support, negotiate and implement all aspects of payer and provider contracting arrangements and ensure that all appropriate operational handoffs from concept to implementation at the national to local level are determined, understood and secured. This will be achieved working in a highly matrixed healthcare services environment. Generally, this individual will need to be able to function in a diverse team environment with multiple internal constituencies, abstract and fluid environments, and simultaneous deadlines. The position will require a solid understanding of financial, legal / regulatory, and operational best practices in FFS and HMO / delegated risk environments. In addition, the position requires excellent communication skills including the ability to create and deliver clear, original and compelling presentations. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Report to the Director of Payer and Provider Contracting and Network Development and work very closely with Care Delivery matrix partners Demonstrate solid understanding of the payer and provider negotiation techniques including the contract negotiation, renewal, and development process to build and maintain performance guarantee strategies and effective reimbursement methodologies to efficiently manage healthcare cost, including the foundational principles of provider-oriented management of medical expense risk pools Implement network development activities for the recruitment and contracting of provider networks in new and prospective markets, and existing market expansions Support new business launch in diverse markets while considering individual market circumstances, provider community, budgeting constraints and available resources Develop strategies to reach financial goals, and execute contracting strategies to meet local and national objectives Contribute to the network development program by working as a key team member to build infrastructure, identify and create resources and assist in operational planning Understand how key contracting scenarios impact / influence healthcare cost and quality performance in all models (From FFS to Full Delegated Risk) Understand how provider incentives can drive performance in all models (from FFS to Full Delegated Risk); Processes include the entire payer claims management life cycle, eligibility & enrollment, marketing, care & referral management, coding and risk adjustment, credentialing, patient / consumer experience, business intelligence and analytics, and general provider revenue cycle and payment integrity environments from both a provider and payer perspective Proactively anticipate and make recommendations to resolve key operational or functional gaps that would prevent the successful implementation of a payer arrangement, product strategy or network strategy Ability to analyze financial, clinical, and operational data to drive improvements in the contract negotiation and implementation process Possess the ability to identify new opportunities or services to enhance the capabilities of the National Provider and Network Strategy team Using one's own proven domain / industry expertise, balance competing priorities in a multi-stakeholder environment Understand all of the latest industry trends around value based contracting, shared savings, and ACO development Possess a good understanding of the healthcare industry from a physician, health plan, and hospital perspective Work closely with other team members and matrixed partners across the organization to accomplish assignments and project milestones. This may include managing and developing new team members over time Work independently with minimal direct supervision Perform other duties, as assigned
Required Qualifications:Minimum BA / BS Possess 7+ years of provider and/or payer managed care contracting experience - preferably including negotiation experience with large physician groups that are accustomed to risk bearing arrangements Medicare Advantage and fee-for-service operations experience Knowledge of Risk Adjustment and STARS methodology 5+ years of review and interpretation of managed care / health services agreements 5+ years of large & complex project leadership experience Superb influencing/persuasion and communication skills Outstanding writing skills including term sheets and contract language Solid analytical and presentation skills, including advanced and prolific PowerPoint and Excel experience 50% travel Preferred Qualifications: Minimum BA / BS required, but an MHA, MPH, or MBA from an accredited program is preferred 5+ years of successful people management experience Other Considerations: High energy / strong work ethic Collaborative profile Ability to treat all constituents on a peer to peer level Self-starter Resourceful / creative Flexible Excellent communication skills Positive attitude and strong team player Ability to thrive in a highly matrixed and fluid environmentCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter PolicyDiversity 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.
Internal Number: 744597
About UnitedHealth Group
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.