Director of Network Contracting - Albuquerque, New Mexico

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The Director of Network Contracting is responsible for the clinical, financial and NPS performance of the Optum IPA physicians and Network Program Managers. The position supports short and long term operational/strategic business activities - by developing, enhancing and maintaining operational information and models for IPA practices. Oversight for contract development and negotiations, department budget planning, IPA performance and strategic growth. Drive overall team strategy and execution, including upholding Optum Standards. They also develop and implement effective/strategic business solutions through research and analysis of data and business processes. This leader is responsible for maximizing the IPA network's performance around quality, coding accuracy and provider satisfaction with market's contracted network. Solid interpersonal relationship and communication skills required as this position will interact daily with physicians and office staff. Ability to hold Network Program Managers accountable for their performance. Adheres to policies, procedures and regulations to ensure compliance and patient safety. Participation in Compliance and other important training is a condition of employment.

Director And Manager Competencies:

• Aligning Performance for Success: Focuses and guides others in accomplishing work objectives
• Gaining Commitment: Uses appropriate interpersonal styles and techniques to gain acceptance of ideas or plans; modifies one's own behavior to accommodate tasks, situations, and individuals involved
• Selecting Talent: Evaluates and selects internal and external talent to ensure the best match between the individual and the work requirements
• Strategic Decision-Making: Obtains information and identifies key issues and relationships relevant to achieving a long-range goal or vision; commits to a course of action to accomplish a long-range goal or vision after developing alternatives based on logical assumptions, facts, available resources, constraints, and organizational values
• Patient Relations: Meets patient and patient family needs; takes responsibility for a patient's safety, satisfaction, and clinical outcomes; uses appropriate interpersonal techniques to resolve difficult patient situations and regain patient confidence
• Business Acumen: Uses economic, financial, market, and industry data to understand and improve clinic business results; uses one's understanding of major business functions, industry trends, and The Group's position to contribute to effective business strategies and tactics
• Developing Others: Plans and supports the development of individuals' skills and abilities so that they can fulfill current or future job/role responsibilities more effectively
• Leadership Disposition: Demonstrates the traits, inclinations, and dispositions that characterize successful leaders; exhibits behavior styles that meet the demands of the leader role
• Planning and Organizing: Establishes courses of action for self and others to ensure that work is completed efficiently

If you are located in Albuquerque, NM, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Development of Provider Contracting strategies and business planning
• Proactively initiate and drive change in processes, tools and capabilities that increase operational efficiency and effectiveness while concurrently improving the consumer experience
• Completes detailed analysis of various reports by tracking and trending data to develop a strategic plan to ensure performance goals are achieved
• Develops a solid relationship with their network providers to ensure provider satisfaction in accordance with Optum Standards and CDO policies and procedures
• Act as liaison between Provider Contracting department and other internal departments to resolve issues and answer questions related to provider contracts, in a timely and efficient manner
• Review and analyze provider contract proposals. Negotiate contract language and financial components of provider agreements
• Provide management oversight for all lines of business financials to assure CDO payments on an aggregate basis are in accordance with contract terms and to determine financial and operational performance and feasibility
• Manage renegotiation of provider contracts on an ongoing basis to maintain competitive rate increases and amend contract terms as may be needed to conform to Optum Standards and CDO's business strategy, legal and regulatory requirements and business development needs
• Wide range of activities pertaining to strategic planning and analysis, medical data analysis (RAF), disease management, chronic care models, and STARs/HEDIS quality interactions
• Educates PCPs and their staff members on health plan products and processes, develops project plans which identify key issues, problems, approaches, performance metrics and resources required and provides staff leadership to multi-disciplinary teams. Serves as a liaison between provider and Optum
• Maintain and obtain contracts within assigned territory
• Assess and interpret customer needs and requirements
• Develop strategies with individual practices and NPMs to assist practices in meeting their performance goals
• 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
• Coach and provide feedback to assigned PCP practices on Optum processes
• Act as a resource for others with new staff or others with less experience
• Performs other duties as assigned

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:

• 7+ years related experience in Provider Contracting with an understanding of managed healthcare
• 5+ years of job-related experience with network data management in a managed care environment
• 5+ years management/supervisory experience
• 3+ years of which are in the health care industry
• Medicare Advantage experience, risk adjustment and working closely with Providers
• Medical terminology, ICD-10, CPT, and HCPC coding
• Understanding of provider compensation structure and good understanding of contract management systems
• Proven complex provider contract negotiation skills
• Proven provider relations skills
• Ability to work for a Hybrid position based in Albuquerque, NM (2x per week in office)
• Ability to travel up to 15% within NM

Knowledge/Skills/Abilities:

• Ability to compile complex reports and develop presentations
• Ability to counsel and/or consult and to lead work teams
• Excellent communication and interpersonal skills
• Excellent analytical and problem-solving skills
• Proven ability to work closely with providers to meet Optum policies and procedures
• Ability to convey complex information to others and make it more easily understood
• Ability to prioritize multiple tasks in an environment of rapid change
• Intermediate proficiency in MS Office (Excel, Access and PowerPoint)
• Ability to organize and prioritize multiple competing priorities
• A proven track of building and fostering relationships at all levels of the organization
• Ability to drive and execute upon department/business priorities
• Proven ability to collaborate and influence internal and external business partners
• Must possess and maintain a valid/current driver's license

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The salary range for this role is $106,800 to $194,200 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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.

OptumCare 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.

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