UnitedHealthcare is a growing company. We stretch in many ways, cross boundaries and, above all, in the way we think. Here, innovation is not about another gadget, it is about transforming the healthcare industry. Ready to make a difference? Make yourself at home with us and start doing the best work in your life.
The more you do, the more you learn. As you read you find new doors that challenge you to bring the best. As a member of our network management team, you will direct the development and support of Provider Networks and unit cost management activities through financial and network pricing modeling, analysis, and reporting. The market has a Commercial product, Medicare Advantage and Managed Medicaid that allow for a variety of strategic opportunities for creative and growth projects.
You will enjoy the flexibility of telecommunications * from affordable distances to Massachusetts or Rhode Island or anywhere in the U.S. as you face difficult challenges.
- Manage unit cost budgets, target setting, performance reporting and associated financial models
- Predict emerging customer needs and develop innovative solutions to meet them
- Help develop geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management
- Evaluate and negotiate contracts with hospital, ancillary and physician providers in compliance with company templates, reimbursement structure standards, established financial targets and other key process controls
- Ensure that network composition includes an appropriate distribution of provider specialties
- Have confidence in leading groups and handling difficult discussions and making decisions with facts and data you have accumulated
- Be responsible for follow up items and managing project plans either on your own or with a cross functional team
- Undergraduate degree or equivalent experience
- 3+ years of experience in a network management-related role handling complex network providers with accountability for business results
- 3+ years of experience being in an external facing role, representing your organization with clients, vendors and/or government officials
- 3+ years of experience managing complex meetings and/or projects
- 2+ years of experience with provider contracting
- 2+ years of experience using financial models and analysis to negotiate rates with providers
- Financial acumen and ability to understand financial modeling and trending
- Proven superior writing skills and ability to convey complex matters in a streamlined manner to a variety of management levels
- Demonstrated interpersonal skills, establishing rapport and working well with others
- Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance
- In-depth knowledge of Medicare Diagnostic Related Group (DRG)
- Expert level of knowledge of Medicare Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.
- Intermediate level of knowledge of claims processing systems and guidelines
- Advanced competency of Excel, including pivot tables
- Advanced competency of other Microsoft Office Suite (Outlook, Word, PowerPoint) and Sharepoint