From Home Provider Network Development Jobs Near Me

Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere. As a team member of our Senior Community Care (SCC) team, we work to provide care to patients in nursing homes, senior housing and assisted living settings. This life-changing work adds a layer of support to improve access to care. We're connecting care to create a seamless health journey for patients across settings. Join us to start Caring. Connecting. Growing together.

The Associate Director, Network Contracting will guide the development and support of provider networks as well as unit cost management activities through financial and network pricing modeling, analysis and reporting.

They will be responsible for developing the provider network, yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and produces an affordable and predictable product for customers and business partners.

The Associate Director, Network Contracting will evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. In addition, it's key for this leader to establish and maintain solid business relationships with the Skilled Nursing Facilities and other business partners to ensure the network composition includes an appropriate distribution of provider specialties.

If you have the ability to work EST or CST standard business hours, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Balance financial and operational impact of contracts to providers, members, UHN, and different customer groups when developing and/or negotiating contract terms
• Develop functional, market level and/or site strategy, plans, production and/or organizational priorities
• Apply network configuration and incentive-based payment models as appropriate to improve quality and efficiency
• Demonstrate understanding of applicable products for different lines of business (Employer and Individual; Medicare and Retirement; Community and State)
• Evaluate current contract performance to identify potential remediation opportunities and/or cost savings
• Demonstrate understanding of and utilize applicable financial tools and reports (internal financial models; external reports) to evaluate performance of current contracts
• Demonstrate understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changes
• Demonstrate understanding of competitor landscape within the market (rates; market share; products; provider networks; market intelligence; GeoAccess)
• Represent department in external meetings to gather relevant information, recommend solutions, execute on deliverables as assigned and explain results/decision/activities
• Develop and/or implement contracting strategies to support new benefits designs and plans

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:

• 5 years of experience in a network management-related role handling complex network providers with accountability for business results
• 2 years of medical cost and affordability experience
• 2 years of experience with provider contracting and/or provider network management
• Experience using financial models and analysis to negotiate rates with providers
• Proven solid knowledge of Medicare and Managed Care Reimbursement
• Driver's License and access to reliable transportation
• Ability to travel 25% to OH/IN
• Ability to work EST standard business hours

Preferred Qualifications:

• Experience with contract negotiations
• Experience developing product pricing and utilizing financial modeling in making rate
• Reside in OH or IN

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 - $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.