Job Description

Strengthen provider networks, collaborative care, or value-based models with (physicians, hospitals, pharmacies, ancillary groups & facilities, etc.) yielding a geographically competitive, stable network that achieves objectives for unit cost performance, trend management, and improved affordability with measurable financial and patient health outcomes. Authors, evaluates, and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls to drive payment innovations. Establishes and maintains strong business relationships with hospital, physician/specialist, pharmacy, and ancillary providers. Collaborate with stakeholders across UHG, Optum, Care Delivery Organizations etc. to ensure clinical affordability projects are aligned with core strategies and goals. Participate in annual business planning and end-to-end designs of innovate payment models or value-based programs and strategies.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.



Primary Responsibilities:

* Lead the development of new concepts, technologies and value-based products to meet emerging requirements and shifts to global risk & delegation authority, capitation, and innovative payment models with supporting business cases and ROI analyses
* Analyze data and develop recommendations on data related to complex and varied business metrics in creating value-based provider reimbursements models, contracts, and programs.
* Manage unit cost budgets, target setting, performance reporting and associated financial models, including incentive-based payment models as appropriate to improve quality and efficiency
* Collaborate with Care Delivery Organizations, Legal, Compliance, etc. to help author and negotiate value-based agreements, with up-side and down-side parameters, performance thresholds, quality and efficiency metrics that are mutually acceptable
* Evaluate market rates and provider performance (e.g., billing patterns; referral patterns; quality and effectiveness) in order to establish provider VBP rates and negotiation strategies
* Monitor and oversee provider, contract, and financial performance to identify opportunities to improve performance and/or provider-specialist relationships, remediation opportunities and/or cost savings
* Utilize applicable financial tools, RVU/Unit tool, and reports (e.g., internal financial models; external reports) to evaluate performance of current contracts
* Examine contract language and provisions in order to assess financial and operational impact and legal implications of requested contract changes
* Demonstrate understanding of competitor landscape within the market (e.g., rates; market share; products; provider networks; market intelligence; GeoAccess)
* Seek information from relevant sources (e.g., COB data; publications; government agencies; providers; provider trade associations) to understand market intelligence information
* Develop and analyze performance reports (e.g. for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies.
* Collaborate cross departmentally to manage risk forecasting/mitigation, project progress and issue resolution efforts
* Liaise between internal and external teams to help steer work stream communications to ensure response integrity
* Influences senior leadership to adopt new ideas, products, and/or approaches that may have segment-wide impact
* Performs all other related duties as assigned

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:

* BS/BA degree in related field, including but not limited to Business, Finance/Accounting, Actuarial Science/Mathematics, Information Management/Data Science
* 7+ years of experience with provider contracting, pricing, reimbursement rates (physicians, hospitals, pharmacies/HIT, ancillary groups & facilities, etc.), network management with accountability for business results
* 7+ years of experience with data analysis, financial modeling, alternative payment methodologies
* 7+ years of experience utilizing financial models and analyses in negotiating rates with provider and ancillary groups, accountable care organizations (ACOs)
* 5+ yeas of experience working with Medicare reimbursement methodologies (in-depth knowledge), i.e. Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, HOPPS, ASP, etc.
* 5+ years of professional project management experience, large and complex projects
* Demonstrated leadership & communication skills in developing content and presenting to various specialist stakeholders
* Advanced MS excel skills including pivots, formulas, calculations, charts, graphs, macros, etc.
* Extensive knowledge of eligibility, claims (institutional, professional, labs, PBM/pharmacy), premiums, capitation, ETG, etc.
* Must have strong prioritization, attention to detail, effective multi-tasking, verbal/written communication and organizational skills.
* Must have the ability to create an effective team environment, build strong relationships.
* Must be solid in solving problems and issues in a matrix environment and communicating effectively at all levels of an organization.
* If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.

Preferred Qualifications:

* MBA or related advance degrees
* Advanced analytical and technical skills, including Tableau, Cognos, Business Objects, SQL, SAS etc.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Colorado Residents Only: The salary range for Colorado residents is $94,500 to $171,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer 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.

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

Job Keywords: Provider Contracting, Financial Modeling, Telecommute, Telecommuter, Telecommuting, Work from home, Work at home, Remote