Director of Pharmacy Network Contracting - Irvine, CA

Director of Pharmacy Network Contracting - Irvine, CA - 549911

Position Description

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 Director of Pharmacy Network Contracting develops the provider network  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. Directors 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 Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties.

In this role you will be expected to:
- Develop and execute strategies for a function or discipline that span a large business unit or multiple markets/sites.
- Apply network configuration and incentive-based payment models as appropriate to improve quality and efficiency.
- Direct others to resolve business problems that affect multiple functions or disciplines.
- Product, service or process decisions are most likely to impact multiple functions and/or customer accounts (internal or external).

OptumRx is one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you'll fill far more than prescriptions. As a member of one of our pharmacy teams, you're empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.

 

** This role will be based in Irvine, CA**



Requirements

Requirements:
- Undergraduate degree or equivalent experience.
- 5-8+ years experience in a network management-related role handling complex network providers with accountability for business results.
- 8+ years experience in the health care industry.
- 5+ years experience in developing of product pricing and utilizing financial modeling in making rate decisions
- 3+ years experience developing and managing a medical cost and administrative budget
- Advanced level of knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.
- 5+ years experience with provider contracting.
- 5+ years of management experience
- Strong customer service skills
- Excellent 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 standards.
- Strong interpersonal skills, establishing rapport and working well with others.

 

Careers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you'll fill far more than prescriptions. As a member of one of our pharmacy teams, you're empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.SM

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Job Details
Contest Number: 549911
Job Title: Director of Pharmacy Network Contracting - Irvine, CA
Job Family: Network Contracting and Pricing
Business Segment: OptumRx
Job Location Information:
Region: North America
Country: United States
City: Irvine
State - Province: California
Other States where Job(s) is Located: ,,,,
Other Cities where job(s) is Located: ,,,,
Additional Job Detail Information:
Employee Status: Regular
Schedule: Full-time
Job Level: Director
Shift: Day Job
Travel: No
Telecommuter Position: No
Overtime Status: Exempt