Position Summary: Develop the institutional network (hospitals, skilled nursing facilities (SNF), ambulatory surgery centers, 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. Evaluate and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Establish and maintain strong business relationships and ensure the network composition includes an appropriate distribution of facilities.
Essential Duties and Responsibilities:
Institutional Contracting Development and Management
- Facilitates strategic discussion with Regional Accountable Teams and senior management resulting in development of coordinated institutional contracting plans for each region.
- Manage unit cost budgets, target setting, performance reporting and associated financial models
- Apply network configuration and incentive-based payment models as appropriate to improve quality and efficiency
- Lead the development of new concepts, technologies and products to meet emerging customer requirements
- Direct cross-functional and/or industry-wide teams with segment-wide and/or enterprise-wide impact
- Influence senior management decisions that impact business direction
- Standardizes and coordinates all institutional contracting programs.
- Collaborates with the Vice President, Contracting in the development and management of work plans for contracting activities.
- Collaborates with Compliance and other teams to ensure that the Contracting department complies and conforms with any regulatory requirements and applicable laws
- Monitors and collaborates with provider network contract management to identify contracting needs and opportunities and expands the institutional contracts as appropriate.
- Identifies and/or creates processes to establish links between Contracting and other Optum PNW departments. Develops and documents internal department's contract requirements.
- Advises the Vice President, Contracting on emerging trends and methodologies in managed care contracting, payor relations and legal issues.
- Represents the organization at external meetings.
Duties listed below are integrated into all job functions:
- All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous and respectful manner toward fellow employees, physicians and patients.
- Must relate to other people beyond giving and receiving instructions: (a) get along with co-workers or peers without exhibiting behavioral extreme; (b) perform work activities requiring negotiating, instructing, supervising, persuading or speaking with others; and (c) respond openly and appropriately to feedback regarding performance from a supervisor.
- Integrates Lean principles, practices and tools to improve operational efficiency, reduce costs and increase customer satisfaction.
- Frequently must follow written and oral instructions as well as complete routine tasks independently.
- Completes annual compliance training on HIPAA/Privacy/Confidentiality/Non-Discrimination/Harassment/Integrity Statement and signs Agreements.
- Ensures confidentiality of patient information following HIPAA guidelines and company policies.
- Attends training to meet requirements of the job position and as needed or mandated by company policies and regulations.
- Has regular and predictable attendance.
- 2+ years of experience in a network management-related role handling complex network providers with accountability for business results
- 8+ years of experience in the healthcare industry
- 5+ years of experience with provider contracting including development of product pricing and utilizing financial modeling in making rate decisions
- 5+ years of experience with provider contracting
- In-depth knowledge of Medicare Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. 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. Here you'll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)
Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers 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. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.