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Director, Healthcare Provider Network Contracting - Facility - Tri-State Area

Company: UnitedHealth Group
Location: Iselin
Posted on: November 26, 2022

Job Description:

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) It's time for us to talk because at UnitedHealth Group, there's never better time to lead. Health care is changing and evolving at a pace that few could have predicted. Technology, ideas and bold vision are taking companies like UnitedHealth Group to new levels of performance. They can help you bring your impact to a whole new level. As a Director within our network contracting team, you'll guide the development and support of provider networks as well as unit cost management activities through financial and network pricing modeling, analysis, and reporting. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 5 leader. Primary Responsibilities:

  • Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management
  • Develop and execute strategies for a function or discipline that span a large business unit or multiple markets/sites
  • Apply network configuration and incentive-based payment models as appropriate to improve quality and efficiency
  • Direct others to resolve business problems that affect multiple functions or disciplines
  • Direct work that impacts entire functions and/or customer accounts (internal or external)
    In this influential, high-impact role, the emphasis will be on setting strategy and working across a matrixed organization to achieve desired results. The environment is fast paced and demanding, so you will be changing priorities often and reacting to the needs of the marketplace. Develops 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, and produces an affordable and predictable product for customers and business partners. Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties. *Employees in jobs labeled with 'SCA' must support a government Service Contract Act (SCA) agreement.
    • Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff
    • Work most often impacts a large business unit, or multiple markets/sites


      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:
      • Undergraduate degree or equivalent experience
      • 8+ years of management experience in a network management-related role handling complex network providers with accountability for business results
      • 5+ years of experience developing product pricing and utilizing financial modeling in making rate decisions
      • 5+ years of experience with provider contracting
      • 3+ years of experience developing and managing a medical cost and administrative budget
      • Expert level of knowledge of Medicare Resource Based Relative Value System (RBRVS), Diagnosis Related Groups, Ambulatory Surgery Center Groups, etc.
      • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation


        To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

        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.

Keywords: UnitedHealth Group, New York , Director, Healthcare Provider Network Contracting - Facility - Tri-State Area, Executive , Iselin, New York

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