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Network Contract Manager II - Remote in Florida

Company: UnitedHealth Group
Location: Miami
Posted on: March 20, 2023

Job Description:

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 life's best work.(sm) -

The Network Contract Manager II is responsible for negotiating and supporting terms of agreement with Specialty and Ancillary providers yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, producing 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 -solid business relationships with Specialty and Ancillary providers and -ensures the network composition includes an appropriate distribution of provider specialties.

If you are located in Florida, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities: -

  • Recruit and contracts with Specialty/Ancillary providers to ensure adequacy standards are met, through ways of targeted chase list(s) and expansion market(s)
  • Negotiates and support terms of agreement with Specialty and Ancillary providers 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
  • Supports redlines of agreements, including but not limited to legal and regularly updates, changes in provider reimbursement and other negotiated terms and/or preclusions
  • Demonstrates understanding of contract language in order to assess financial and operational impact, including legal implications of requested contract changes, aligned with business objectives
  • Demonstrates understanding of contract policies to ensure compliance and consistent contracting across the Enterprise
  • Demonstrates knowledge of competitive landscape within respective market space (e.g. rates, market share, product lines, market intelligence, GeoAccess)
  • Establishes and maintains solid business acumen with Specialty and Ancillary providers, ensuring the network composition includes an appropriate distribution of provider specialties to meet adequacy
  • Implements and support local, regional and/or national initiatives and directives through contracting strategies and communication efforts
  • Implements contracting strategies to support new benefit designs and plans
  • Coordinates with legal, finance and contract services team to ensure proper, timely contract load and payment configuration
  • Ensures relevant contract and demographic information is loaded, timely, accurate and consistent in applicable platform(s) in order to support network review
  • Ensure processes are consistent with CMS, state, and federal regulations and guidelines
  • Maintains confidentiality at all times, given handling of sensitive, contract, health plan and provider information
  • Performs all other related duties as assigned

    You'll 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. -
    Required Qualifications: -

    • Undergraduate degree or equivalent work experience
    • 4+ years of experience in a network management related role, such as contracting/recruiting or provider services
    • Ability to solve moderately complex problems and adapt to process variances in situations where limited standardization exists
    • Excellent written and presentation skills in order to easily communicate to diverse audiences
    • Exceptional time management and organizational skills to balance multiple priorities in a fast paced working environment
    • Proficiency with Microsoft Office applications to include Word, Excel, Visio, PowerPoint, SharePoint, Microsoft Teams and Outlook
    • Ability to travel up to 25%

      Preferred Qualifications: -

      • -3+ years of experience in fee schedule development using actuarial models
      • Legal and/or compliance professional work experience
      • Work experience directly or indirectly with a Managed Service Organization (MSO) and firm understanding of value-based care model and Medicare Advantage products
      • Proven in-depth knowledge of Medicare Resource Based Relative Value System (RBRVS)
      • Demonstrated intermediate level of knowledge of claims processing systems and guidelines
      • Working knowledge of health care reimbursement practices, utilization management requirements, claims handling procedures, health insurance benefit administration and risk-based reimbursement


        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) -

        WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth. -

        *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy -


        At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. - - - -

        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. -

Keywords: UnitedHealth Group, Miami , Network Contract Manager II - Remote in Florida, Executive , Miami, Florida

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