Senior Network Contract Manager - Remote

Improve the lives of others while Caring. Connecting. Growing together.

Job Description
- Senior Network Contract Manager
- Remote (2381957)

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.

In support of Optum’s mission, vision, and strategic goals, this position is responsible for building and maintaining a high-quality, high-performing specialty contract network. Reporting to the Vice President of Contracting and Payer Strategy, the Specialty Network Contract Manager creates, evaluates, and maintains Optum Care’s provider network (specialist physicians, pharmacies, ancillary, facilities, primary care physicians etc.). Success looks like a competitive, stable network that demonstrates the Quadruple Aim and Network Adequacy.

You are the first step in the evaluation and negotiation of proposed provider contracts in compliance with federal and state laws, company contract templates, provider strategy, and other key process controls. Ensures contracting tactics foster efficient and effective implementation through delegated and contracting providers. Establishes and maintains strong and trusted business relationships with provider network.

You’ll enjoy the flexibility to work remotely
* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Works within department strategic vision, objectives, and policies and procedures. Participates in building objectives each year
• Regularly meet with cross-functional team to assist in creating, evaluating and adjusting strategy for assigned provider groups to meet overall performance goals. Provides explanations and interpretations within area of expertise
• Establish and maintain effective business relationships with potential and existing network providers on behalf of the organization
• Participate in various department, leadership, or cross-functional meetings including Medical Directors, finance, operational team, and clinical staff
• Recruit/contract specialist providers to build the networks in alignment with the overall growth strategy
• Negotiate new contracts to ensure maximum revenue, operational efficiency and compliance
• Play key role in the creation of local network and execution of network structure, assuring network adequacy and a high-performing specialist contracted network, who score high on provider satisfaction surveys
• Work with operational leaders to ensure effective operational implementation and adherence of payment and authorization practices is handed off appropriately
• Ensure specialist providers have in-depth understanding of Optum Care model to navigate AR process, prior auth process, as well as meet quality goals, manage utilization / cost performance, contract performance (e.g. shared savings achieved), contractual obligations. Introduce and advocate company resources to facilitate practice optimization
• Maintain open and trusting communication with specialist providers and direct them to appropriate network managers to resolve issues related to credentialing, claims, eligibility, disease management, utilization management, quality, and risk adjustment programs
• Collaborate, communicate, and manage specialist provider relationships including but not limited to complete Practitioner Data Forms, Provider Change Forms, membership attribution, Credentialing status, provider directories, system access, and other operational questions as needed
• Request detailed analysis of various performance and trending data to identify opportunities to improve network construction and appropriately tier providers. Demonstrated ability to understand performance results and key drivers that impact results
• Assess and interpret customer needs and requirements
• Identify solutions to non-standard requests and problems
• Work with minimal guidance; seek guidance on most complex tasks
• Translate concepts into practice
• Coach, provide feedback, and guide others
• Ability to engage directly with senior-level management, providers
• Demonstrate benefits of…