Network Provider Contract Manager - Midwest - Ohio - Remote

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Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

In this behavioral health Outpatient Clinician contracting role, the emphasis will be on completing all recruitment and contracting activities required for behavioral health Outpatient Clinicians in the state of OH. Once providers are accepted into the networks, this role is also responsible for ongoing provider rate updates and contract maintenance, in accordance with established contracting and rate guidelines. There may be times when this role is responsible for recruiting behavioral health Outpatient Clinicians, should there be network adequacy and access gaps identified in the Commercial, Medicare or Medicaid networks or client specific requests.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Preference to those who reside within the mid-west region. Ohio preferred. Or have a deep familiarity with the Ohio area.

Primary Responsibilities

• Recruit and contract with behavioral health Outpatient Clinicians to assure Optum behavioral health has Commercial, Medicare and Medicaid networks that meet Adequacy and Access standards, client expectations and achieve objectives for provider reimbursement that meets annual budget goals
• Complete contracting tasks required to negotiate provider rate increases, complete adding new networks that an Outpatient clinician may want to join, or other contracting events required to maintain the provider in our networks
• Complete rate renewals with providers identified for rate remediation opportunities and/or fee schedule updates
• Work closely with Provider Relations Team, key internal stakeholders, and Project Managers to ensure network and contracting goals are met
• Clearly communicate the status of large network development and contracting initiatives to internal and external customers
  
  

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 1 years of related experience in contracting
• 2 years experience in contracting with an understanding of contract language and financial implications;
• 1 years of experience in using financial models and analysis to negotiate rates
• Proven skilled in working within Excel spreadsheets and manipulating data in Excel (basic formulas and pivot tables)
• Proven good communication skills; key for developing relationships and being able to communicate proposed contract terms to reach mutually acceptable agreement
  
  

Preferred Qualifications

• Certified Coder
• Behavioral Health experience
• Knowledge in claims processing and billing/coding guidelines
• In-depth knowledge of Medicare Resource Based Relative Value System (RBRVS)
• Advanced understanding of Managed Care (Facility and Outpatient) contract language
• Exceptional understanding of Medicaid and Medicare pricing and CMS relativity
• Understanding of different reimbursement methodologies and products (i.e. commercial, Medicare & Medicaid)
• Medicaid, Medicare Advantage and Commercial Contracting for Behavioral Health
• Proven background in behavioral health contracting; understanding the different levels of care and provider types
• Reside within the mid-west region. Ohio preferred. Or have a deep familiarity with the Ohio area
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
  
  

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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

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