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)The VP Network Contracting develops Medicaid and Dual Special Needs Plans 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, and produces an affordable and predictable product for customers and business partners. The VP of Network Contracting evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Responsibilities also include establishing and maintaining strong business relationships with State regulators, Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the Medicaid network composition includes an appropriate distribution of provider specialties. Primary Responsibilities:Develop and execute Medicaid strategies for a function or discipline that span a large business unit or multiple markets / sitesApply network configuration and Medicaid incentive-based payment models as appropriate to improve quality and efficiencyDirect others to resolve business problems that affect multiple functions or disciplinesProduct, service or process decisions are most likely to impact multiple functions and/or customer accounts (internal or external)Medicaid focused role
Required Qualifications:Undergraduate degree or equivalent experience8+ years of experience in a network management - related role handling complex network providers with accountability for business results8+ years of experience in the health care industry, with at least 5 of that in Medicaid5+ years of Medicaid experience in developing of product pricing and utilizing financial modeling in making rate decisions3+ years of experience developing and managing a medical cost and administrative budgetExpert level of knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.5+ years of experience with provider contracting and incentive programs5+ years of management experiencePreferred Qualifications:Strong customer service skills communicating and managing relationships with State regulatorsExcellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others, including but not limited to reimbursement policy standardsStrong interpersonal skills, establishing rapport and working well with othersCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM 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: Medicaid, State regulations, VP, Network Contracting, Raleigh, NC, Charlotte, NC, North Carolina
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.