Senior Hospital Network Manager - North Carolina

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 16 million people who receive our unique blend of packages and programs. 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.



Job Responsibilities:
Responsible for initiating and leading complex negotiations with geography-specific highest volume hospitals and associated very large physician medical groups in accordance with UnitedHealthcare contract templates, reimbursement structure standards, and other key UnitedHealthcare process controls.
Manages all facets of relationships with geography-specific highest volume in-network hospitals, yielding a geographically competitive, broad access, stable hospital network that achieves objectives for unit cost performance and yields an affordable and predictable product for customers and business partners.
Develops and executes hospital network and negotiation strategies that positively impact financial performance of UnitedHealthcare.
Accountable for all network development/expansion and management activities with Tier 1 hospitals and associated very 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 with Tier 1 hospitals and very large physician medical groups.
Leads negotiations with Tier 1 hospitals and very 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 and/or hospital/provider group specific unit cost targets.
Monitor respective geography-specific unit cost performance and improve competitiveness, breadth and stability of Tier 1 hospital network.
Develop and successfully implement geography-specific unit cost improvement plans for hospital network.
Determine network adequacy and fill Tier 1 hospital network gaps at geography-specific competitive rates in accordance with unit cost targets.
Ensure integrity of Tier 1 hospital network with UnitedHealthcare policies and compliance with pertinent regulatory guidelines.
Accountable for relevant components of provider relationship management including leading hospital Joint Operating Committee (JOC) meetings 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.
Monitor activities related to 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.
Build Value to Customers: Develops and operates a competitive stable Tier 1 hospital network 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 Tier 1 hospital network.


Job Requirements:

Qualifications:
Seven to ten 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.
Expert level of knowledge of 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



Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V