Network Performance Manager – New Mexico

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. 

Positions in this function are responsible for the successful program design, compliance with network requirements, network assessment and selection, and program/product implementation. This includes enterprise-wide Clinically Integrated Network teams that focus on specific clinical area Lines of Service (e.g., Cardiology, Women’s Health, Oncology, etc.) to improve the quality and affordability through improvements in appropriateness and effectiveness. May perform network analysis and strategy development and implementation. Obtains data, verifies validity of data, and analyzes data as required. Analyzes network availability and access. May make recommendations regarding use, expansion, selection of networks for various products based on that analysis

This is a field based position in Albuquerque, NM. There will be 50% travel throughout New Mexico required for this role.

Majority of the travel will be local to Albuquerque (within 2-3 hours).

Primary Responsibilities: 

• Review employer group/health plan expectations (e.g., commercial; government) in order to determine the potential impact to employer group/health plan membership
  
• Gather data from relevant sources in order to respond to stakeholders’ requests (e.g., employer groups; internal teams)
  
• Analyze network and/or provider performance along key indicators (e.g., compliance with regulatory audits; financial performance; Benefit Cost Ratio; risk adjustment scores; prevalence rates; Unit Cost Reduction Trend) in order to determine which programs to implement and/or modify 
  
• Research competitor and external information regarding key network characteristics and contracting strategies in order to develop products and programs 
  
• Ensure relevant contract and demographic information is loaded into the applicable platform in order to support analysis and review
  
• Review and/or analyze member/provider population information (e.g., cultural information; demographics; geographic coverage) in order to determine potential network gaps in care and risk adjustment indicator opportunities 
  
• Implement new rates with contracted providers based on provider performance
  
• Validate network data for programs (e.g., transparency program) 
  
• Develop metrics and create performance reports for payforperformance programs (e.g., PBC; PCPI)
  
• Determine performance metrics and programs to apply to specific providers based on competitive data, internal data (improvement opportunities) and applicable legal and regulatory requirements 
  
• Provide guidance to internal stakeholders regarding administration of contracts (e.g., contract language; coding) 
  
• Identify needs and create infrastructure and parameters for programs/networks/contracts (e.g., contract language; clinical quality initiatives; internal support)
  
• Communicate with key stakeholders (e.g., network management contractors) to ensure programs/networks/contracts comply with standards 
  
• Provide input and feedback to senior leadership in order to suggest/recommend improvements to programs/networks/contracts
  
• Coordinate with relevant internal and/or external stakeholders to ensure that programs/networks/contracts are designed and implemented to meet local, regional, and/or national market needs 
  
• Create and/or implement communication/training materials (e.g., talking points; FAQs; step action chart; metric evaluation tools) in order to educate affected stakeholders on new programs and/or processes
  
• Conduct visits with external health care providers to promote risk adjustment score accuracy (e.g., early detection; accurate documentation and coding) and compliance with applicable regulatory guidelines (e.g., CMS; HEDIS/STARS Quality Measures)
  
• Work with local, regional, and/or national networks and/or stakeholders in order build support for program/contract implementation
  
• Seek feedback from relevant internal and/or external stakeholders regarding potential program/network improvement opportunities and needs
  
• Conduct proactive outreach with external stakeholders (e.g., health care providers; health plan) to demonstrate the value of services and offerings 
  
• Collaborate with relevant internal and/or external stakeholders to resolve issues and obstacles with network/program/contract performance
  
• Collaborate with the contracting team to ensure adherence to internal contracting standards
  
• Communicate with applicable stakeholders to provide performance updates regarding program/contract implementation (e.g., objectives; goals; timelines; schedules; issues; performance against standard contract agreements)
  
• Followup with stakeholders to ensure issues have been resolved and addressed effectively and timely Manage external relationships with thirdparty vendors to ensure program SLAs are met

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: 

• 3+ years of clinical or managerial experience in Healthcare Operations OR 3+ years of claims experience OR 3+ years of experience within a managed care environment OR 3+ years of provider relations experience 
  
• Understanding of healthcare value-based concepts, payment methodology, and fee for service reimbursement methodologies across various specialties and facilities
• Advanced knowledge of Microsoft PowerPoint; proficiency in Microsoft Excel and Word
  
• Ability to travel 50% of the time in New Mexico
• Driver’s License and access to reliable transportation

Preferred Qualifications:  

• 3+ years of experience with network contracting in a managed care environment
  
• STARs experience  
  
• Network Data experience – contracts/rates/configuration
  
• Experience with EMR’s
  
• Experience in managed care working with network and provider relations/contracting 
  
• Medical/clinical background 
  
• Financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models) 
  
• Knowledge of the Medicare market 
  
• Knowledge base of clinical standards of care and preventive health 
  
• Understanding of and utilize applicable financial tools (e.g., HPM; PPM; FAT; HCE’s RVU/Unit tool) and reports (e.g., internal financial models; external reports) to develop rates
  
• Understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changes
  
• Understanding of competitor landscape within the market (e.g., rates; market share; products; provider networks; market intelligence; GeoAccess)
  
• Ability to utilize appropriate contract management systems (e.g., Emptoris; PEGA; Contract Attachment Repository) to author and execute contracts and to access supplemental contractual documents

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.  

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.    

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.   

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.