Sr Ntwk Contract Mgr - Remote in UT, ID or CO

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.    

In support of Optum's mission, vision, and strategic goals, this position is responsible for building and maintaining a high-quality, high-performing specialty contract network. Reporting to the Vice President of Contracting and Payer Strategy, the Specialty Network Contract Manager creates, evaluates, and maintains Optum Care's provider network, including specialist physicians, primary care providers, pharmacies, ancillary providers, and healthcare facilities.

Success is defined by the development and maintenance of a competitive, high-performing provider network that supports Network Adequacy standards and advances the Quadruple Aim. You will lead the evaluation and negotiation of provider contracts in compliance with federal and state regulations, company contract templates, provider strategy, and key process controls. This role ensures contracting strategies foster efficient implementation and operational excellence while establishing and maintaining trusted business relationships with providers and key stakeholders.

If you are located in Uta, Idaho, or Colorado, you will have the flexibility to work remotely* as you take on some tough challenges. This position requires approximately 25%25 travel throughout the assigned market to support provider contracting, network development and relationship management activities.

Primary Responsibilities: 

• Work within department strategic vision, objectives, policies, and procedures while participating in annual goal-setting activities
• Regularly meet with cross-functional teams to create, evaluate, and adjust provider strategies to meet overall performance goals
• Establish and maintain effective business relationships with prospective and existing network providers
• Participate in leadership, departmental, and cross-functional meetings with Medical Directors, Finance, Operations, and Clinical teams
• Recruit and contract specialty providers to build networks aligned with organizational growth strategies
• Negotiate provider contracts to maximize value, operational efficiency, and compliance
• Play a key role in the development and execution of local network strategies, ensuring network adequacy and a high-performing specialist network
• Collaborate with operational leaders to ensure successful implementation of contractual payment and authorization processes
• Educate providers on the Optum Care model, including prior authorization processes, utilization management, quality goals, cost performance expectations, and shared savings opportunities
• Maintain open communication with providers and facilitate resolution of issues related to credentialing, claims, eligibility, disease management, utilization management, quality, and risk adjustment programs
• Manage provider relationships and support activities including Practitioner Data Forms, Provider Change Forms, credentialing status, provider directory updates, membership attribution, and system access
• Analyze provider performance and market trends to identify opportunities for network improvement and provider tiering strategies
• Assess and interpret customer needs and business requirements
• Identify solutions to non-standard requests and complex business challenges
• Work independently with limited guidance while seeking support on highly complex issues
• Translate strategic concepts into operational practices
• Coach, mentor, and provide feedback to others as appropriate
• Demonstrate solid contract negotiation skills
• Engage effectively with senior leadership and provider executives
• Communicate the benefits of various reimbursement methodologies to providers and internal stakeholders
• Build credibility quickly and influence stakeholders at all organizational levels
• Demonstrate exceptional interpersonal skills when interacting with physicians, office staff, hospital executives, and health plan personnel
• Effectively prioritize work and manage deadlines
• Gather and evaluate market intelligence from providers, trade associations, government agencies, publications, and other relevant sources
• Successfully operate within a matrixed organizational environment
• Demonstrate solid verbal and written communication skills
• Utilize data analysis and reporting to support business decisions
• Prepare and deliver presentations to both small and large audiences
• Reside within Utah, Idaho, or Colorado and maintain the ability to travel up to 25%25 throughout the region to support provider contracting and network development activities
• Maintain intermediate proficiency in Microsoft Word, Excel, PowerPoint, and Teams
• Demonstrate working knowledge of Medicare reimbursement methodologies including RBRVS, DRGs, Ambulatory Surgery Center Groupers, and related payment models
• Demonstrate working knowledge of HEDIS measures, CPT codes, and HCPCS coding systems
• Demonstrate working knowledge of CMS-HCC Risk Adjustment methodology
• Collaborate with leadership and the Network Pricing team to evaluate financial arrangements and recommend reimbursement methodologies including Fee-for-Service, Case Rates, Sub-Capitation, and Pay-for-Performance models

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: 

• 3+ years of experience in a healthcare network management-related role such as contracting, provider services, or network development
• 3+ years of experience in fee schedule development utilizing actuarial models
• 3+ years of experience using financial models and analysis to negotiate provider reimbursement rates
• 3+ years of experience performing network adequacy analysis
• 2+ years of experience working with a managed care organization, health insurer, or consulting organization in a network or contract management capacity
• Proven in-depth knowledge of Medicare Resource-Based Relative Value System (RBRVS)
• Proven intermediate knowledge of claims processing systems and related guidelines
• Reside within Utah, Idaho, or Colorado 
• Ability to travel up to 25%25 throughout the region

Preferred Qualifications: 

• 2+ years of project management or project leadership experience
• Expertise in physician, facility, and ancillary reimbursement methodologies
• Expertise negotiating physician, facility, and ancillary provider contracts
• Established knowledge of the local provider community
• Solid analytical and problem-solving skills with the ability to contribute to business strategy development and drive execution

*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 $91,700 - $163,700 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 help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.