Network Contract Manager
About The Position
At UnitedHealthcare, the Network Contract Manager helps develop and support provider networks and unit cost management activities through financial and network pricing modeling, analysis, and reporting. The role focuses on negotiating and maintaining provider contracts, particularly with FQHC/RHCs in the South Atlantic market and Government Focus provider groups. It supports geographically competitive, broad-access, stable networks and achievement of unit cost performance and trend-management objectives. The manager oversees unit cost budgets, targets, performance reporting, and related financial models; ensures appropriate provider-specialty distribution; and supports Government risk-contracting goals. The role provides day-to-day management of risk-contracting activities, including project management, issue resolution, and execution and maintenance of capitation contracts. It involves cross-functional work with lines of business, organizational leaders, HCE, and Capitation Operations, as well as explaining difficult issues, coaching, and guiding others. The environment is described as intense and fast-paced, with data challenges and process gaps requiring solutions.
Requirements
- At least 2 years of experience in the health care industry.
- At least 2 years of experience in a network management-related role, such as contracting, provider services, or provider data operations.
- In-depth knowledge of Medicare Resource Based Relative Value System (RBRVS).
- Ability to prioritize tasks and work effectively under time constraints.
- Excellent verbal and written communication skills.
- Ability to build key internal and external business relationships to meet the needs of customers and partners.
Nice To Haves
- At least 3 years of experience with large provider contracting, including product pricing development and use of financial modeling in rate decisions.
- At least 2 years of experience in fee schedule development using an actuarial model.
- At least 2 years of experience using financial models and analysis to negotiate provider rates.
- At least 2 years of experience performing network adequacy analysis.
- Experience in health plans with a demonstrated focus on capitation/value-based contracting.
Responsibilities
- Evaluate and negotiate contracts in compliance with company templates, reimbursement structure standards, and process controls, focusing on FQHC/RHCs in the South Atlantic market and Government Focus provider groups.
- Manage unit cost budgets, target setting, performance reporting, and associated financial models.
- Guide development of geographically competitive, broad-access, stable networks that achieve unit cost performance and trend-management objectives.
- Ensure network composition includes an appropriate distribution of provider specialties.
- Support the Government Risk Contracting Manager/Director in achieving risk-contracting goals and objectives for all Government lines of business.
- Manage day-to-day risk-contracting activities, including project management, problem resolution, and activities supporting capitation contract execution and maintenance.
- Work across lines of business and the organization, including with LOB leaders, HCE, and Capitation Operations.
- Provide explanations and information to others on difficult issues.
- Coach, provide feedback, and guide others.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase plan, subject to eligibility requirements.
- 401(k) contribution, subject to eligibility requirements.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
