Hospital Contracting Manager - Michigan
UnitedHealth Group (Detroit, Michigan)

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UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.

UnitedHealthcare, a UnitedHealth Group company, provides network-based health and well-being benefits and services for employers and consumers nationwide. We use our strength, diversity and innovation to improve the lives of the more than 18 million people who receive our unique products and services. And our endless pursuit for excellence in everything we do extends to your career as well. Join us today for an inspired and purposeful mix of professional growth opportunities and personal rewards.

 

Initiate and lead negotiations with any or all of the following in accordance with UnitedHealthcare contract templates, reimbursement structure standards, and other key UnitedHealthcare process controls:

Ancillary providers; Moderate volume Hospitals (Tier 1, 2 and 3); and/or Large Physician groups.Manage all facets of relationships the geography-specific set of in-network Ancillary providers, moderate volume (Tier 2 and 3) Hospitals, and/or large Physician groups yielding a geographic-specific competitive, broad access, stable provider network that achieves objectives for unit cost performance and yields an affordable and predictable product for customers. Develop and execute negotiation strategies that directly impact financial performance of UnitedHealthcare.
Accountable for all network development and management activities with ancillary providers, Tier 1, 2 and 3 hospitals, and/or large physician medical groups in accordance with UnitedHealthcare standards and key process controls to achieve market/region/division/company objectives. Responsible for leading and implementing network strategy, financial analyses, and language/cost negotiations for a specific set of ancillary providers, Tier 1, 2 and 3 hospitals and/or large physician medical groups. Leads negotiations with ancillary providers, Tier 2 and 3 hospitals and/or large physician medical groups in their network geography. When applicable, work with and involve relevant stakeholders (regional and corporate network management, internal customers, network pricing, etc.) in negotiation decisions impacting legal or regulatory requirements, contract standards and cost targets. Develop and successfully perform to geography-specific unit cost targets. Monitor geography-specific unit cost performance and improve competitiveness, breadth, and stability of ancillary, Tier 2 and 3 hospital, and/or large physician medical group networks. Develop and successfully implement geography-specific unit cost improvement plans for ancillary, Tier 2 and 3 hospital, and/or large physician medical group networks. Determine network adequacy and fill ancillary, Tier 2 and 3 hospital, and/or large physician medical group network gaps at geography-specific competitive rates in accordance with unit cost targets. Ensure integrity of ancillary, Tier 2 and 3 hospital, and/or large physician medical group networks with UnitedHealthcare policies and compliance with pertinent regulatory guidelines. Accountable for relevant components of provider relationship management, including leading Joint Operating Committee (JOC) meetings, as necessary, and provider outreach/communication. Promote use of electronic provider on-line self-service tools in order to support and achieve operational efficiency yielding reduced costs to serve the relationship. Perform and monitor activities related to the contract load process; engage appropriate service organization for claims resolution; ARO; EDI; provider service/performance issues; and provider appeals. Provide advice/guidance/recommendations to senior management regarding health care costs; cost savings opportunities; best practices; provider performance issues; and network expansion. Maintain highest personal/professional integrity and enforce Principles of Integrity and Compliance. Four to eight years in a network development/contract management role, such as contracting, purchasing, etc. Bachelors degree in business, health care management, or related field. Significant additional experience may be considered in lieu of a Bachelors degree, at the discretion of the hiring manager. Demonstrated effective negotiation skills and implementation/influencing skills High degree of proficiency in utilizing and interpreting financial models and network adequacy analyses. Strong knowledge of RBRVS, Ambulatory Surgery Center groupers, per diem, per case, DRG and APC reimbursement methodologies and clear understanding of Medicare and UnitedHealthcare claims processing guidelines. Experience applying pricing, financial analyses, hospital bill audit results and contract standards to the development of Requests for Proposals and negotiation strategies. Problem solving skills, including the ability to systematically analyze complex problems, draw relevant conclusions, and successfully devise/implement appropriate solutions calmly. Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others. Proficient in speaking in both individual and group settings. Ability to multi-task, shifting back and forth effectively among multiple activities. Possesses good interpersonal skills, establishing rapport and working well with others. Demonstrated leadership skills Performance Driven: Achieves stretch unit cost objectives and ensures that all Ancillary, Tier 2 and 3 Hospital, and/or large Physician group contracts are in compliance with UnitedHealthcare contract template standards. High-Velocity Change: Drives network initiatives to achieve targeted growth, IOI, and operating targets to better position UnitedHealthcare?s networks competitively. Operating Efficiency: Implements and operates an Ancillary, Tier 2 and 3 Hospital, and/or large Physician group network that is in compliance with UnitedHealthcare process controls and standards. Facilitates reduction in total cost to meet customer and business partner expectations of Ancillary providers, Tier 2 and 3 Hospitals, and/or large Physician groups. Top-Performing Employees Are Our Greatest Asset: Fosters a competitive environment internally and serves as a role model/mentor to other employees seeking career development in network management. Cutting Edge: Consistently demonstrates ability to act and react swiftly to network challenges. Build Value to Customers: Develops and operates a competitive, stable Ancillary, Tier 2 and 3 Hospital, and/or large Physician group networks with broad access that meets stretch unit cost objectives and provides customers products at predictable/affordable cost. Accountability Through Matrix Management: Works collaboratively across functional areas to ensure superior operational efficiency of Ancillary, Tier 2 and 3 Hospital, and/or large Physician group networks.Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/VUnitedHealth Group is a drug-free workplace.  Candidates are required to pass a drug test before beginning employment.