Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Analyze and evaluate medical and high-cost drug reimbursement for various contracting approaches and methodologies
Manage a high volume of time sensitive single case agreements involving multiple providers, medical services and high cost drugs
Work with several data sources to evaluate and develop market rates and provider performance profiles (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
Reviewing contract redlines and developing responses that adhere to the applicable legal, financial, regulatory, and operational requirements
Work across internal and external functional areas to address and resolve provider issues
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:
4+ years of experience in a network management-related role handling network providers with accountability for business results
2+ years of experience with provider contracting including development of product pricing and utilizing financial modeling in making rate decisions
Proven knowledge of various rate methodologies such as bundle/case rate methodology, drug pricing, Medicare Resource Based Relative Value System (RBRVS), DRGs, etc.
Proven knowledge of Medicare and Medicaid regulations
Intermediate to advanced level of proficiency with MS Excel
Ability to travel up to 10%
Preferred Qualifications:
Familiarity with government pricing and coding
Familiarity with high-cost drug pricing and coding
Cellular therapy or complex condition provider contracting
Proven excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others, including but not limited to reimbursement policy standards
*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 re 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 $89,800 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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.
UnitedHealth Group
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