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Job: Network Account Manager - Honolulu, HI

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Jobing Description

Position Description

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)

The Network Contract Manager develops the provider network (physicians, ancillary groups & facilities, 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. Network Contract Managers evaluate and negotiate 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,or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties. The Network Contract Manager is also responsible for ensuring accurate provider data submissions for contract and amendment loading, and may include auditing for adherence to quality measures and reporting standards.

Primary Responsibilities:

  • Assess and interpret customer needs and requirements

  • Identify solutions to non - standard requests and problems

  • Solve moderately complex problems and / or conduct moderately complex analyses

  • Work with minimal guidance; seek guidance on only the most complex tasks

  • Translate concepts into practice
  • Provide explanations and information to others on difficult issues

  • Act as a resource for others with less experience

  • Reviews the work of others and provides recommendations for process improvement

Required Qualifications:

  • Undergraduate degree or equivalent work experience
  • 4+ years of experience in a network management - related role, such as contracting or provider services

  • In-depth knowledge of Medicare reimbursement methodologies, i.e. Resource Based Relative Value System (RBRVS)

  • 3+ years of experience in fee schedule development

  • 3+ years of experience utilizing financial models and analysis in negotiating rates with providers

  • At least an intermediate level of knowledge of claims processing systems and guidelines

  • 3+ years of experience in performing network adequacy analysis

Preferred Qualifications:

  • 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 form others
  • Strong interpersonal skills, establishing rapport and working well with others

  • Strong customer service skills

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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 where ever 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

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: healthcare, managed care, network contracting, negotiations, process improvement, Hawaii, Oahu, Honolulu, ancillary, physician contracting, Honolulu, HI, Hawaii

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