1+ months

Network Development Manager - Telecommute in West TX - 928356

San Antonio, TX 78205 Work Remotely
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  • Job Code
    928356

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your lifes best work.(sm)

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Jobs related to provider network contract negotiation and pricing support the development of geographically competitive, broad access, stable provider network that is both affordable and predictable.

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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.

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If you are located in the state of TX, you will have the flexibility to telecommute* as you take on some tough challenges. This position has focus on West Texas specifically.

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Primary Responsibilities:

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  • Generally work is self-directed and not prescribed
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  • Works with less structured, more complex issues
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  • Serves as a resource to others
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  • Assesses and interprets customer needs and requirements
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  • Identifies solutions to non-standard requests and problems
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  • Solves moderately complex problems and/or conducts moderately complex analyses
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  • Works with minimal guidance; seeks guidance on only the most complex tasks
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  • Translates concepts into practice
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  • Provides explanations and information to others on difficult issues
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  • Coaches, provides feedback, and guides others
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  • Acts as a resource for others with less experience
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  • Evaluate / Analyze Current Contract and Market Performance ""
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    • Demonstrate understanding of applicable products for different lines of business (e.g., Employer and Individual; Medicare and Retirement; Community and State)
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    • Analyze UCRT associated with products, markets, and/or providers to assess performance against budget
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    • Evaluate current contract performance to identify potential remediation opportunities and/or cost savings
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    • 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 evaluate performance of current contracts
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    • Demonstrate understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changes
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    • Demonstrate understanding of competitor landscape within the market (e.g., rates; market share; products; provider networks; market intelligence; GeoAccess)
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    • Seek information from relevant sources (e.g., COB data; publications; government agencies; providers; provider trade associations) to understand market intelligence information
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  • Develop / Negotiate / Support Terms of Agreement with Providers ""
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    • Balance financial and operational impact of contracts to providers, members, UHN, and different customer groups when developing and/or negotiating contract terms
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    • Weigh financial and operational information to evaluate continued provider participation
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    • Interact and consult with Network Pricing team to evaluate different financial arrangements and to identify and recommend applicable payment methodologies (e.g., FFS; Case Rate; Sub-capitation; Pay for Performance) in order to maximize value for stakeholders
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    • 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
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    • Demonstrate understanding of contract policies to ensure compliance and consistent contracting across theenterprise
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    • Demonstrate understanding of contract language and terms of agreement in order to ensure that financial / operational impact and legal implications are aligned with business objectives
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    • Utilize appropriate contract management systems (e.g., Emptoris; PEGA; Contract Attachment Repository) to author and execute contracts and to access supplemental contractual documents
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    • Demonstrate understanding of submission tools (e.g., Delegation Authority Grids; loading grids; Navigator; BPM) to ensure accurate and timely contract configuration for customer groups
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    • Demonstrate understanding of contractual financial and non-financial terms
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    • Evaluate market rates and provider performance (e.g., billing patterns; referral patterns; quality and effectiveness) in order to establish provider rates and negotiation strategies
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    • Communicate proposed contractual terms with provider and negotiate mutually acceptable agreement
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  • Manage Provider Relationships""
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    • Explain the organization's direction and strategy to internal partners and providers in order to justify methodologies, processes, policies, and procedures
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    • Demonstrate benefits of applicable reimbursement methodology to internal partners and providers
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    • 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
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    • 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
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    • Report back information from provider meetings to applicable stakeholder (e.g., manager; business partner) in order to determine appropriate action
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    • Monitor and/or oversee provider financial performance to identify opportunities to improve performance and/or provider relationship
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    • Communicate contractual and/or operational performance to providers to ensure compliance with contractual terms and protocols
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    • Demonstrate understanding of provider termination process
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    • Educate providers on the organization's processes, policies, and procedures in order to ensure provider compliance and ease of administration
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  • Develop / Implement / Execute / Support Market Strategies""
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    • Implement local, regional, and/or national initiatives and directives (e.g., ICD10; medical necessity language) through contracting strategies and communication efforts
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    • Manage UCRT associated with products, markets, and/or providers to identify potential market strategies
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    • Identify and share best practices (e.g., payment methodologies; negotiation tactics) with national and regional colleagues
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    • Modify and/or develop new payment methodologies in order to execute market strategies
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    • Present and discuss industry and market trends with internal and/or external groups (e.g., customer groups; brokers; professional associations; providers) in order to facilitate market strategy development and implementation
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    • Monitor and/or oversee network performance and industry trends to identify opportunities to refine, develop, and/or implement market strategies
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    • Represent department in internal meetings (e.g., medical management; M&R; C&S) to gather relevant information, present / recommend solutions, and provide updates on results / decision/ activities
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    • Develop and/or implement contracting strategies to support new benefits designs and plans
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Youll 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.

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Required Qualifications:

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  • Undergraduate degree or equivalent experience
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  • 4+ years of experience in a network management-related role, such as contracting or provider services
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
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Preferred Qualifications:

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  • In-depth knowledge of Medicare Resource Based Relative Value System (RBRVS)
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  • 3+ years of experience in fee schedule development using actuarial models
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  • 3+ years of experience using financial models and analysis to negotiate rates with providers
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  • Intermediate level of knowledge of claims processing systems and guidelines
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  • Knowledge of network adequacy analysis
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  • Experience working with Medicare Advantage Plans
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Values Based Competencies:

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  • Integrity Value: Act Ethically"""
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    • Comply with Applicable Laws, Regulations and Policies
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    • Demonstrate Integrity
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  • Compassion Value: Focus on Customers""
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    • Identify and Exceed Customer Expectations
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    • Improve the Customer Experience
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  • Relationships Value: Act as a Team Player""
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    • Collaborate with Others
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    • Demonstrate Diversity Awareness
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    • Learn and Develop
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  • Relationships Value: Communicate Effectively""
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    • Influence Others
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    • Listen Actively
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    • Speak and Write Clearly
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  • Innovation Value: Support Change and Innovation""
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    • Contribute Innovative Ideas
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    • Work Effectively in a Changing Environment
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  • Performance Value: Make Fact-Based Decisions""
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    • Apply Business Knowledge
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    • Use Sound Judgement
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  • Performance Value: Deliver Quality Results""
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    • Drive for Results
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    • Manage Time Effectively
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    • Produce High-Quality Work
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Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

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*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

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Diversity 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.

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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords: Network Development Manager, Network Development, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH, San Antonio, TX, Texas

Posted: 2021-05-19 Expires: 2021-07-21

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Network Development Manager - Telecommute in West TX - 928356

UnitedHealth Group
San Antonio, TX 78205

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