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The Director of Network Contracting will drive development of the provider network (physicians, hospitals, pharmacies, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management. The developed network will produce an affordable and predictable product for customers and business partners. The position is responsible for the clinical, financial and NPS performance of the Optum IPA physicians and Network Program Managers. The position supports short and long term operational/strategic business activities - by developing, enhancing and maintaining operational information and models for IPA practices. Oversight for contract development and negotiations, department budget planning, IPA performance and strategic growth. Drive overall team strategy and execution, including upholding Optum Standards. They also develop and implement effective/strategic business solutions through research and analysis of data and business processes. This leader is responsible for maximizing the IPA network’s performance around quality, coding accuracy and provider satisfaction with market’s contracted network. Solid interpersonal relationship and communication skills required as this position will interact daily with physicians and office staff. Ability to hold Network Program Managers accountable for their performance. Adheres to policies, procedures and regulations to ensure compliance and patient safety.
Director And Manager Competencies:
- Aligning Performance for Success: Focuses and guides others in accomplishing work objectives
- Gaining Commitment: Uses appropriate interpersonal styles and techniques to gain acceptance of ideas or plans; modifies one’s own behavior to accommodate tasks, situations, and individuals involved
- Selecting Talent: Evaluates and selects internal and external talent to ensure the best match between the individual and the work requirements
- Strategic Decision-Making: Obtains information and identifies key issues and relationships relevant to achieving a long-range goal or vision; commits to a course of action to accomplish a long-range goal or vision after developing alternatives based on logical assumptions, facts, available resources, constraints, and organizational values
- Patient Relations: Meets patient and patient family needs; takes responsibility for a patient’s safety, satisfaction, and clinical outcomes; uses appropriate interpersonal techniques to resolve difficult patient situations and regain patient confidence
- Business Acumen: Uses economic, financial, market, and industry data to understand and improve clinic business results; uses one’s understanding of major business functions, industry trends, and The Group’s position to contribute to effective business strategies and tactics
- Developing Others: Plans and supports the development of individuals’ skills and abilities so that they can fulfill current or future job/role responsibilities more effectively
- Leadership Disposition: Demonstrates the traits, inclinations, and dispositions that characterize successful leaders; exhibits behavior styles that meet the demands of the leader role
- Planning and Organizing: Establishes courses of action for self and others to ensure that work is completed efficiently
- Adaptability/Flexibility: Ability to adapt quickly as a high growth less mature business contributes to a dynamic, fluid, high learning work environment
If you are located within Illinois, you will have the flexibility to work remotely as you take on some tough challenges.
Primary Responsibilities:
- Drive potential provider partner outreach and manage provider partnership process from development of the pipeline through the contracting process
- Responsible for the development of Provider Contracting strategies and business planning
- Proactively initiate and drive change in processes, tools and capabilities that increase operational efficiency and effectiveness while concurrently improving the consumer experience
- Completes detailed analysis of various reports by tracking and trending data to develop a strategic plan to ensure performance goals are achieved
- Develops a solid relationship with their network providers to ensure provider satisfaction in accordance with Optum Standards
- Act as liaison between Provider Contracting department and other internal departments to resolve issues and answer questions related to provider contracts
- Review and analyze provider contract proposals. Negotiate contract language and financial components of provider agreements
- Manage renegotiation of provider contracts on an ongoing basis to maintain competitive rate increases and amend contract terms as may be needed to conform to Optum Standards and CDO’s business strategy, legal and regulatory requirements and business development needs
- Responsible for a wide range of activities pertaining to strategic planning and analysis, medical data analysis (RAF), disease management, chronic care models, and STARs/HEDIS quality interactions
- Educates PCPs and their staff members on health plan products and processes, develops project plans which identify key issues, problems, approaches, performance metrics and resources required and provides staff leadership to multi-disciplinary teams. Serves as a liaison between provider and Optum
- Maintain and obtain contracts within assigned territory
- Develop strategies with individual practices and NPMs to assist practices in meeting their performance goals
- Predicts emerging customer needs and develops innovative solutions to meet them
- Solves unique and complex problems with broad impact on the business
- Leads large, complex projects to achieve key business objectives
- Influences senior leadership to adopt new ideas, products, and/or approaches
- Directs cross-functional and/or cross-segment teams
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:
- 7+ years job related experience with network data management, provider contracting or provider relations in a managed care environment. 3+ of which are in the health care industry
- 5+ years management/supervisory experience
- Medicare Advantage experience, risk adjustment and working closely with Providers
- Medical terminology, ICD-10, CPT, and HCPC coding
Knowledge/Skills/Abilities:
- Ability to compile complex reports and develop presentations
- Ability to counsel and/or consult and to lead work teams
- Excellent communication and interpersonal skills
- Excellent analytical and problem-solving skills
- Proven ability to work closely with providers to meet Optum policies and procedures
- Ability to convey complex information to others and make it more easily understood
- Ability to prioritize multiple tasks in an environment of rapid change
- Intermediate proficiency in MS Office (Excel, Access and PowerPoint)
- Ability to organize and prioritize multiple competing priorities
- A proven track of building and fostering relationships at all levels of the organization
- Ability to drive and execute upon department/business priorities
- Proven ability to collaborate and influence internal and external business partners
- Possess and maintain a valid/current driver’s license
Physical Demands:
Rarely (Less than .5 hours/day); Occasionally (0.6 - 2.5 hours/day); Frequently (2.6 - 5.5 hours/day); Continuously (5.6 - 8.0 hours/day)
- Standing - Rarely
- Sitting - Continuously
- Walking - Occasionally
- Lifting - Light to 10 lbs
*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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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