Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)
We are seeking a Network Contract Manager for growth and expansion in the Texas market, which will include new development and current ongoing development efforts. Network Contract Managers develop 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. They evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Responsibilities also include establishing and maintaining strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties.
Assess and interpret customer needs and requirements
Identify solutions to non-standard requests and problems
Solve moderately complex problems and/or conduct moderately complex analyses
Work with minimal guidance; seek guidance on only the most complex tasks
Translate concepts into practice
Provide explanations and information to others on difficult issues
Coach, provide feedback, and guide others
Act as a resource for others with less experience
2 years of experience in a network management-related role, such as contracting or provider services
2 years of experience utilizing financial models and analysis in negotiating rates with providers
2 years of experience in performing network adequacy analysis
In-depth knowledge of Medicare reimbursement methodologies, i.e. Resource Based Relative Value System (RBRVS)
Access to reliable transportation and ability to travel 90% when expanding new markets; overnight stays may also be required
Knowledge of claims processing systems and guidelines
Excellent communication and interpersonal skills
Strong customer service skills
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 90,000 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)
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.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Network contract manager, network management-related role, contracting,provider services,Dallas, San Antonio, TX, Texas
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Website : https://www.optumcare.com
We’re passionate about serving, connecting and improving the whole health system for everyone in it. Optum™ is a health services and innovation company on a mission to help make the health system work better for everyone. We combine data and analytics with technology and expertise to power modern health care. In collaboration with our partners, we focus on three key drivers of transformative change: modernizing the health system infrastructure, advancing care and empowering consumers. Serving the whole system Partnering with 300 health plans to ensure positive changes take root in the broader health system and benefit the most possible people. Supporting hundreds of life sciences companies as they research and develop new treatments. Working with 67,000 pharmacies to help people get the care and treatments they need. Helping half of the Fortune 500 employers meet their employees’ health and wellness needs Serving care providers and health systems — including four out of five U.S. hospitals — to support their focus on quality care, better patient experiences, operational efficiency and cost savings. Partnering with government agencies in 40 states and, increasingly, around the world. Helping 74 million people find the right care at the best value, understand their options and take charge of their health and wellness. We are inspired to always work harder, aim higher, and deliver on our values of integrity, compassion, relationships, innovation and performance for everyone we serve. We never forget that, ultimately, the work we do has an impact on the lives of real people every day. From sharing new discoveries to celebrating healthy victories, see the latest news and events to learn how Optum is collaborating with our partners and communities to help make the health system work better for everyone. Powering modern health care requires a special team – people who envision a healthier future, people who challenge the status quo and people who are driven by compassion and possibility. If you want your work to make a powerful difference in the lives of others, explore an Optum career today.