Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm) Primary Responsibilities: Participate in the negotiation; implementation, and operational issue resolution of all NAMM California health plan contracts Act as a liaison with health plans and NAMM Operations Departments Responsible for negotiating health plan contracts / amendments. Evaluates current contracts, renegotiates where applicable, and applies managed care reimbursement principles (capitation, per diems, creative reimbursement, etc.) to maximize cost savingOversight of the implementation process of payor contracts / amendments and issues with internal Operations, tracking renewals, financial analysis associated with payor contracts, and creation of contract tools for internal uses Oversees the development of the Health Plan Operations program and staff while managing departmental projects All other duties as assigned by Vice President of Contracting, Claims and Configuration Revenue Recovery Program - 8 total. Billing, Third party liability, recovery
Required Qualifications:3 years management experience of the Payor Contracting process from preparation, negotiation, implementation with an ability to understand key contract structure, Division of Financial Responsibility (DOFR) & their financial implications An individual with a strong understanding of the healthcare industry and or local physicians market, managed care alternative delivery systems, as well as knowledge of relevant federal and state regulations Experience with the California marketplace, including the Delegated Model Strong experience with capitation payments used by managed care organizations (healthcare service providers)Strong understanding of health care delivery system or management service organization (MSO) operationsKnowledge of operational process within the MSO/IPA model Computer proficiency in Excel, PowerPoint, Word, OutlookAbility to develop Power Point presentations and basic formatting with utilization of databases and spreadsheets Preferred Qualifications:Bachelor's Degree in a related field or 3 - 5 years equivalent, related to health care experience Ability to communicate written & orally in an effective & diplomatic manner Skill in organizing information and prioritizing goals & responsibilities Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) North American Medical Management, California, Inc. (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and manages provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform. The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: Payor contract, management, director, provider network, network operations, contracts, provider contracts, IPA, delegated model, capitation, Irvine, CA, California
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.