Optum
Senior network contracting manager will drive development of 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. The developed network will produce an affordable and predictable product for customers and business partners.
If you are located in St. Louis, MO, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities
Conducts outreach to potential providers, researching to identify the correct contact and doing cold calling
Drives development of the provider network (physicians, pharmacies, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for cost performance
Selling the Optum value proposition to new potential providers via video calls and in person meetings
Performs contract negotiation and pricing - evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls
Establishes and maintains solid business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties
Balance financial and operational impact of contracts to providers, members, and different customer groups when developing and/or negotiating contract terms
Support evaluation of market rates and provider performance (e.g., billing patterns; referral patterns; quality and effectiveness) in order to establish provider rates and negotiation strategies
Explain the organization's direction and strategy to internal partners and providers in order to justify methodologies, processes, policies, and procedures
Identify and gather information regarding provider issues in order to develop and/or implement strategy to resolve matter, keep manager informed of progress, or elevate issue to appropriate internal business partner
Represent department in external meetings (e.g., ancillary providers; physician groups; facilities) to gather relevant information, recommend solutions, execute on deliverables as assigned and explain results/decision/activities
Monitor and/or oversee provider financial performance to identify opportunities to improve performance and/or provider relationship
Monitor and/or oversee network performance and industry trends to identify opportunities to refine, develop, and/or implement market strategies
Other duties as assigned
Key Work Attributes
Reviews the work of others. Provides explanations to others on the most complex issues
Develops innovative approaches
Sought out as expert/Serves as a leader/mentor
Anticipates customer needs and proactively develops solutions to meet them
Serves as a key resource on complex and/or critical issues
Ability to adapt quickly as an high growth less mature business contributes to a dynamic, fluid, high learning work environment
Forecasts and plans resource requirements
May lead functional or segment teams or projects
Motivates and inspires other team members
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.
Qualifications - External Required Qualifications
3+ years of experience with network contracting or provider relations in a managed care environment
Demonstrate understanding of and utilize applicable financial tools and reports (e.g., internal financial models, external reports) to develop rates
Demonstrate understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changes
Demonstrate understanding of competitor landscape within the market (e.g., rates, market share, products, provider networks, market intelligence, GeoAccess)
Demonstrated ability to utilize appropriate contract management systems (e.g., Emptoris, PEGA, Contract Attachment Repository) to author and execute contracts and to access supplemental contractual documents
Preferred Qualifications
Proven success in a sales environment
#J-18808-Ljbffr
If you are located in St. Louis, MO, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities
Conducts outreach to potential providers, researching to identify the correct contact and doing cold calling
Drives development of the provider network (physicians, pharmacies, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for cost performance
Selling the Optum value proposition to new potential providers via video calls and in person meetings
Performs contract negotiation and pricing - evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls
Establishes and maintains solid business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties
Balance financial and operational impact of contracts to providers, members, and different customer groups when developing and/or negotiating contract terms
Support evaluation of market rates and provider performance (e.g., billing patterns; referral patterns; quality and effectiveness) in order to establish provider rates and negotiation strategies
Explain the organization's direction and strategy to internal partners and providers in order to justify methodologies, processes, policies, and procedures
Identify and gather information regarding provider issues in order to develop and/or implement strategy to resolve matter, keep manager informed of progress, or elevate issue to appropriate internal business partner
Represent department in external meetings (e.g., ancillary providers; physician groups; facilities) to gather relevant information, recommend solutions, execute on deliverables as assigned and explain results/decision/activities
Monitor and/or oversee provider financial performance to identify opportunities to improve performance and/or provider relationship
Monitor and/or oversee network performance and industry trends to identify opportunities to refine, develop, and/or implement market strategies
Other duties as assigned
Key Work Attributes
Reviews the work of others. Provides explanations to others on the most complex issues
Develops innovative approaches
Sought out as expert/Serves as a leader/mentor
Anticipates customer needs and proactively develops solutions to meet them
Serves as a key resource on complex and/or critical issues
Ability to adapt quickly as an high growth less mature business contributes to a dynamic, fluid, high learning work environment
Forecasts and plans resource requirements
May lead functional or segment teams or projects
Motivates and inspires other team members
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.
Qualifications - External Required Qualifications
3+ years of experience with network contracting or provider relations in a managed care environment
Demonstrate understanding of and utilize applicable financial tools and reports (e.g., internal financial models, external reports) to develop rates
Demonstrate understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changes
Demonstrate understanding of competitor landscape within the market (e.g., rates, market share, products, provider networks, market intelligence, GeoAccess)
Demonstrated ability to utilize appropriate contract management systems (e.g., Emptoris, PEGA, Contract Attachment Repository) to author and execute contracts and to access supplemental contractual documents
Preferred Qualifications
Proven success in a sales environment
#J-18808-Ljbffr