Senior Network Contract Manager - Remote

UnitedHealth Group•Eden Prairie, MN

4h•$91,700 - $163,700•Remote

About The Position

This self-directed role is responsible for the development, contracting, and ongoing management of OptumHealth's Cell and Gene Therapy (CGT) Centers of Excellence (COE) provider network, including leading complex provider negotiations to establish single case and network agreements with academic medical centers, large health systems, community-based oncology and hematology practices, and specialty pharmacies across all lines of business. This position requires a high degree of independence, advanced provider contracting experience, solid financial acumen, and the ability to manage complex provider relationships and negotiations across a highly matrixed organization. In this role, you will execute network strategies to meet client and sales objectives; conduct financial and rate modeling to deliver competitive reimbursement arrangements; advance payment methodologies to align with the line of business; conduct coding and reimbursement research for emerging CGT products; support the resolution of case setup, operational, and contract administration issues; and establish and maintain solid provider relationships to support network performance and operational objectives. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

4+ years of experience in provider network management or contracting role managing complex provider relationships and negotiations with accountability for business results
2+ years of experience in provider contracting, including the development of reimbursement methodologies and product pricing, and the use of financial modeling to support rate-setting decisions
Knowledge of bundled payment and case rate methodologies, Medicare Resource-Based Relative Value Scale (RBRVS), Diagnosis-Related Groups (DRGs), and related reimbursement methodologies
Knowledge of Medicare and Medicaid regulations
Intermediate to advanced level of proficiency in Microsoft Excel

Nice To Haves

Experience with high-cost cell and gene therapies, organ transplants, or cancer specialties

Responsibilities

Evaluate and negotiate contracts in accordance with company contract templates, reimbursement methodologies, compliance requirements, and other key process controls
Analyze and evaluate bundled payment arrangements and high-cost drug reimbursement methodologies related to Cell and Gene Therapy (CGT) services
Leverage multiple data sources to analyze market rates, provider performance metrics, and utilization trends to support reimbursement strategies and contract negotiations
Communicate organizational strategy, contracting methodologies, reimbursement approaches, policies, and operational requirements to providers while negotiating mutually acceptable agreements
Assess the financial impact of contract terms and reimbursement arrangements to support business objectives and network strategy
Manage provider relationships and navigate operational, legal, financial, and clinical matters
Review contract redlines and develop responses that align with applicable legal, financial, regulatory, and operational requirements
Collaborate with provider executive leadership, internal stakeholders, and cross-functional teams across a highly matrixed organization to resolve issues and support network objectives