Associate Director of Healthcare Provider Network Contracting / Medicaid - Georgia

Company: UnitedHealth Group
Location: Macon
Posted on: January 15, 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)The Associate Director of Network Contracting -develops the provider network (physicians, hospitals, pharmacies, ancillary, 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. The role -evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Responsibilities also include establishing and maintaining strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties. This role covers the Southeast region, and does include provider visitation and presentations. If you are located in Georgia, you will have the flexibility to telecommute* as you take on some tough challenges.Primary Responsibilities:

• Evaluate and negotiate contracts in compliance with company contract templates, and other key process controlsYou'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:
  • 10+ years of experience in the Healthcare industry with Managed Care
  • 5+ years of experience with Provider Contracting, preferably with Tier One / Hospital / ACO providers
  • 4+ years of experience with Medicaid and Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRG's, Ambulatory Surgery Center Groupers, etc
  • 4+ years of experience leading or contributing to projects
  • 3+ years of experience developing and delivering presentations to mid or senior level provider staff
  • Intermediate level of proficiency with MS Excel, PowerPoint and Office Software
  • 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 compliancePreferred Qualifications:
    • Great relationship skills, be a very strategic thinker, takes an optimistic approach to challenges, and -a team orientated individual
    • Experience with UHN/UHC process, provider contracting and payment reform models (episodes, PCMH, ACO)
    • Comfortable taking ownership and accountability for projects
    • Experience in population health and clinical transformation
    • Work directly with the UHN Market Lead and Provider Relations Lead to understand necessary contracting and provider education activities related to state specific initiatives -
    • Complete ad hoc data analysis to support inquiries from Community and State segment leaders, compliance, or the state regulators
    • Ability to communicate effectively with various levels of leadership
    • Set up reoccurring meetings with key Community and State leaders to review items that require action and execution by UHN market.
    • Advanced negotiation skills; ability to gain acceptance from others on a plan or idea and achieve bottom line results for the company
    • Able to work effectively in an ambiguous environment 5+ years experience in contributing to the development of product pricing and utilizing financial modeling in making rate decisions
    • Solid customer service skills
    • Excellent relationship and -communication skills (verbal and written)
    • Must reside in the state of GeorgiaTo protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination 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 10 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 wherever 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)*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.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: -Associate Director of Network Contracting / Medicaid, GA, Georgia, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote

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