Sr. Director, Provider Network Negotiations; Cypress, CA-Hybrid

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.

Manage the team of contract negotiators for the provider network (physicians, pharmacies, 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. 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 Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties. Monitor contract performance and address non-compliance with any providers with the providers. Provide support to regional medical directors by identifying trends in utilization and new technology or coding that would have an impact to business.

• Provide leadership to and be accountable for the performance of managers and/or senior level professional staff within the Optum CA service area
• Lead the detailed design of the Contract Negotiations Lane as part of the broader organization redesign of the Network Contracting department.
• Develop functional, market level, and/or site strategy, plans, production and/or organizational priorities to support the goals and objectives of the regional markets
• Identify and resolve technical, operational, and organizational problems outside own team
• Demonstrate understanding of applicable products for different lines of business (e.g., Employer and Individual; Medicare and Retirement; Community and State)
• Analyze UCRT associated with products, markets, and/or providers to assess performance against budget
• Evaluate current contract performance to identify potential remediation opportunities and/or cost savings
• Demonstrate understanding and utilize applicable financial tools (e.g., HPM; PPM; FAT; HCE's RVU/Unit tool) and reports (e.g., internal financial models; external reports) to evaluate performance of current contracts
• Demonstrate understanding of contract language 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; Geo Access)
• Seek information from relevant sources (e.g., COB data; publications; government agencies; providers; trade associations) to understand market intelligence information
• Balance financial and operational impact of contracts to providers, members, UHN, and different customer groups when developing and/or negotiating contract terms
• Weigh financial and operational information to evaluate continued provider participation
• Interact and consult with Network Pricing team to evaluate different financial arrangements and to identify and recommend applicable payment methodologies (e.g., FFS; Case Rate; Sub-capitation; Pay for Performance) in order to maximize value for stakeholders
• Demonstrate understanding of and utilize applicable financial tools (e.g., HPM; PPM; FAT; HCE's RVU/Unit tool) and reports (e.g., internal financial models; external reports) to develop rates
• Demonstrate understanding of contract policies to ensure compliance and consistent contracting across the enterprise
• Demonstrate understanding of contract language and terms of agreement in order to ensure that financial/operational impact and legal implications are aligned with business objectives
• Utilize appropriate contract management systems (e.g., Emptoris; PEGA; Contract Attachment Repository) to author and execute contracts and to access supplemental contractual documents
• Demonstrate understanding of submission tools (e.g., Delegation Authority Grids; loading grids; Navigator; BPM) to ensure accurate and timely contract configuration for…