Senior Network Contract Manager - Remote
About The Position
This self-directed role with OptumHealth will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. You will manage contracts, cost trend, relationships and network growth/strategy for Optum’s Centers of Excellence provider networks (transplant, cancer, congenital heart disease and VAD) through provider negotiations with large academic hospitals and health systems. This position is responsible for executing on network strategies to meet client and sales goals; contracting competitive rates; evolving the payment methodology to align with the line of business; and managing provider relationships. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Requirements
- 5+ years of experience in a network management-related role handling complex network providers with accountability for business results
- 5+ years of experience in the health care industry
- 2+ years of experience with provider contracting including development of product pricing and utilizing financial modeling in making rate decisions
- In-depth knowledge of Medicare Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.
- Knowledge of Medicare and Medicaid regulations
- Intermediate level of proficiency with MS Excel and other Microsoft Office applications
Nice To Haves
- Experience with in vivo gene therapy COE networks
Responsibilities
- Analyze and evaluate payment appendices to strategize options for various contracting approaches and methodologies
- 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 providers in order to justify methodologies, processes, policies, and procedures
- Input contract projections accurately into appropriate tools and analyze financial impact of provider contracts to achieve company goals
- Communicate proposed contractual terms with provider and negotiate mutually acceptable agreement
- Establish and manage relationships with providers to navigate operational, legal, financial and clinical matters
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
