For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
The Director of Network Contracting will drive development of the provider network (physicians, hospitals, pharmacies, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management. The developed network will produce an affordable and predictable product for customers and business partners. The position 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.
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
Adaptability/Flexibility - Ability to adapt quickly as an high growth less mature business contributes to a dynamic, fluid, high learning work environment
If you are located within Midwest region, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
Drive potential provider partner outreach and manage provider partnership process from development of the pipeline through the contracting process
Responsible for the 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
Act as liaison between Provider Contracting department and other internal departments to resolve issues and answer questions related to provider contracts
Review and analyze provider contract proposals. Negotiate contract language and financial components of provider agreements
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
Responsible for a 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
Develop strategies with individual practices and NPMs to assist practices in meeting their performance goals
Predicts emerging customer needs and develops innovative solutions to meet them
Solves unique and complex problems with broad impact on the business
Leads large, complex projects to achieve key business objectives
Influences senior leadership to adopt new ideas, products, and/or approaches
Directs cross-functional and/or cross-segment teams
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 job related experience with network data management, provider contracting or provider relations in a managed care environment. 3+ of which are in the health care industry
5+ years management/supervisory experience
Medicare Advantage experience, risk adjustment and working closely with Providers
Medical terminology, ICD-10, CPT, and HCPC coding
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
Possess and maintain a valid/current driver's license
Physical Demands:
Rarely (Less than .5 hours/day); Occasionally (0.6 - 2.5 hours/day); Frequently (2.6 - 5.5 hours/day); Con