WA Outpatient Behavioral Health Contract Manager

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

 

If you are located in Washington, you will have the flexibility to work remotely* as you take on some tough challenges

 

Primary Responsibilities:

• Telecommute position 
• Person will work Pacific Standard Time (PST) or slightly modified schedule to work primarily with Washington State behavioral health provider community during their business hours 8 am to 5 pm PST
• Serve as contracting leader and subject matter expert for Washington State Medicaid Special Programs, including Community Behavioral Health Support Services (CBHSS)/1915i Waiver, 1115 Waiver/ Jail Re-Entry Program and other Medicaid special services
• Activities include recruitment and contracting functions for the building and ongoing maintenance of a high quality, competitive Washington State Medicaid network that meets all access & availability and regulatory standard/requirements
• Handling all Washington State Health Care Authority State Reporting requirements for Special State Programs
• Accountable for all system updates associated with Washington State Medicaid contract negotiations/network changes/addition of new providers and programs
• Attendance at the various internal and extern meetings with State, Provider and Health Plan stakeholders in Washington State
• Support annual Washington State HCA TEAMonitor preparations for CBHSS Program
• Partners on Washington State Medicaid Network Strategy development
• Washington State Medicaid, Medicare and commercial outpatient behavioral health and facility recruitment and contracting; this includes end-to-end contracting processes for new programs and products and serving as a contracting subject matter expert  
• Might include responsibilities in other states too
• Regular interface and leadership role with UHC health plan leadership, internal behavioral health functional leadership including finance and underwriting, provider leadership, and state regulators
• Work with behavioral health economics, legal, finance and underwriting in development, maintenance and monitoring of provider payment arrangements
• Presents and reports verbally and in writing to state regulators (examples in WA State include Health Care Authority, Department of Social and Health Services, Department of Corrections, Department of Health, Department of Commerce) via conference calls about Medicaid contracting, provider contracting, network adequacy, recruitment development and related topics
• Meets with, presents to, and negotiates on behalf of Medicaid Health Plan with Behavioral Health – Administrative Service Organizations (BH-ASOs) regarding reimbursement, service, delegation or other revisions to Crisis Administrative Service Agreement and delegation and related exhibits
• Develops new, unique base behavioral health (outpatient and facility) contract templates, statements of work and payment appendices for Washington Medicaid programs for discussion, review and approval within organization and eventual submission for approval by WA Office of Insurance Commission and WA
• Health Care Authority
• Understands standard behavioral health provider reimbursement, such as fee for service and per diem. Has working knowledge of behavioral health CPT codes and Washington State SERI (Service Encounter Reporting Instructions)
• Understands alternative reimbursement methods used for Washington Medicaid including Population-Based Payment, Capitation, Case Rates, and Per Member Per Month (PMPM)
• Uses higher-level discernment and decision-making abilities that enable someone to support and work with upper level-management and state regulators
• When interacting with providers, manages clear provider expectations about timelines for contracting, credentialing, reimbursement levels and methodology, site audits, and the like
• Develops and maintains primary network contracting relationships with external (e.g., behavioral health providers, behavioral health groups, behavioral health agencies/community mental health agencies/federally qualified health clinics, facilities, provider associations, tribal government and other tribal organizations, government agencies) and internal customers; these relationships will be positive and productive
• Issues provider applications, agreements and related documents to providers
• Gathers completed provider applications and other documents that accompany the application, other documents required by state law and/or company policy; review these documents for completeness, accuracy, organize, and submit documents for credentialing
• Assembles provider agreements consisting of base agreements, appendices and addendums, fee schedules and related documents
• Coordinates and follows-up with provider relations advocates to ensure timeliness of submission of applications and related documents
• Is continually engaged; promptly responds to external and internal customer inquiries; responsible for remaining engaged with external and internal customers until tasks are complete; responsible for proactively keep external and internal customers updated about status of requests; communicates with external and internal customers via phone and email and using each appropriately to develop strong working relationships, this includes being prepared for scheduled calls with customers and writing professional communications
• Understands our provider contracts and contract language, terms and conditions and occasionally review provider’s proposed language changes and occasionally draft counter language for review by supervisor and legal counsel)
• Models: personal responsibility, dependability, reliability and flexibility in being able to meet the needs of the team and business; accepts responsibility and accountability for actions; continually learns and retains/absorbs knowledge, information and skills to perform the position as you work independently
• Models integrity and honesty; behaves in an honest, fair, and ethical manner; if says work is complete, it truly is complete and accurate according to standards. Takes the “higher road” when it comes to conflict
• Models stewardship of recourse and documents; is efficient and effective with use of work time; archives and saves fully executed agreements, current fee schedules and related documents in appropriate locations; responsible with public (Medicaid and Medicare) and private funds when negotiating reimbursement in provider agreements
• Reports to the Director of Outpatient Behavioral Health Contracting of the Western U.S.; Keep Director updated on timely basis about provider network development, contracting developments, rate negotiations, rate increase requests, emerging issues and the like; actively participates in Western U.S. Outpatient
• Behavioral Health Contracting Team Meetings and collaborates with peers
• Use proprietary and other software programs for sending, updating and storage of provider/agency/group/facility contracts and numerous fee schedules and related contractual documents
• Develops, updates and maintains numerous fee schedules
• Actively participates in scheduled and ad hoc joint Provider Relations – Outpatient Behavioral Health Contracting Meetings to ensure continuity of communication and coordination between; proactively copies provider relations colleagues on provider communications to keep them in the loop about provider communications
• Actively participates on a regular basis with a variety of internal meetings with various functional areas including but not limited to provider services/provider relations, network strategy, legal, other contracting teams, project managers, health care economics, finance, underwriting, clinical, clinical operations, compliance, claims, consumer affairs, information technology, and sales
• Communicates throughout each workday via emails and phone communication with internal and external customers
• Works in a fast-paced work environment with multiple competing priorities
• Required to work office hours of 8:00 am to 5:00 pm PST as a telecommuter in order to respond to internal and external customers; this is a salaried position and will require more than 40 hours per week at times to keep up with work or complete work assignments

 

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:

• Experience contracting with providers for Washington State Medicaid Special Programs 
• Experience interacting with Washington State Health Care Authority, Washington State Department of Social and Health Services, Washington State Department of Corrections and other State agencies
• Experience submitting reports to Washington State Health Care Authority
• 3+ years of health care/managed care experience that includes the following: 
  • Working at a health plan / managed care organization contracting with medical and/or behavioral health outpatient and facility providers
  • Negotiating behavioral health contracts between behavioral providers and health plans / managed care providers for commercial, medicare and/or medicaid lines of business
  • Working with cpt codes
  • Interacting with behavioral health professionals and/or behavioral health organizational leaders when working with prospective providers
  • Significant hands-on experience with medical / facility and/or behavioral health provider contracting in the WA State market 
  • Solid working knowledge of Washington State geography, counties, cities and provides (hospitals, clinics and other providers by location)
  • Proficiency using Excel to develop and analyzing behavioral health fee schedules using Excel
  • Proficiency with MS Word, Excel, PowerPoint and Access
  • Understanding and experience with health plan reimbursement, finance and underwriting principles
  • Ability to: use tact and diplomacy; use superior discernment in stakeholder and provider communications; communicate effectively, professionally and comfortably with staff at multiple levels and from multiple functional areas and from various professional fields within provider/agency/group/facility organizations

 

Preferred Qualifications:

• 2 + years experience with two or more of the following:
  • Washington State provider contracting experience
  • High level of proficiency working with Excel spreadsheets, analyzing fee schedules, developing and maintaining fee schedules, and analyzing provider reimbursement increase requests
  • Experience working with health plan finance and/or underwriting staff developing provider payment strategies, reimbursement amounts, fee schedules and payment tables
  • Behavioral health contracting experience in with states contiguous to Washington State
  • Experience working with health plan legal counsel reviewing contract language modifications
  • Basic understanding of role of Washington State Department of Health, Washington State Health Care Authority, Washington Department of Insurance Commissioner and Washington Department of Social and Health Services, and Washington Department of Children, Youth and Families as they related to Medicaid
  • insurance plans and provider services; understanding of similar systems in Arizona, California and/or other Western U.S. States
  • Working knowledge of Washington State: behavioral health providers and their major locations and key services, provider community; geography and understanding of urban, suburban, rural and tribal communities-including name of counties, tribal nations, cities, towns and their location to one another; Medicaid
  • MCOs and regional service areas; Commercial and Medicare health plans
  • Knowledge of Medicare and CMS
  • Prior experience working for State of Washington in a relevant position
• Exceptional verbal and written communications
  • Use appropriate demeanor, wear business appropriate dress, body language during interpersonal communications via video conference calls and in-person meetings
  • Use appropriate business language in written communications (emails, memos and letters) that are tailored to the to the situation and immediate audience / personalities
  • Foresee potential distribution and use of written (especially email) communications to audiences if later shared elsewhere by the recipient (e.g., executives, providers, regulators and media)  
  • Ability to use tact and diplomacy when applicable, and use superior discernment in both internal and external stakeholder in both verbal and written communications on topics when communicating on a sensitive topic
  • Ability to confidently interact and communicate with individuals-internally and externally-in a variety of organizations levels and roles
  • Ability to always be courteous and professional (“taking the higher road”) when interacting internal or external stakeholders regardless of how they behave or act
  • Ability to work with providers/agencies/groups and tell them “no” to various contract and reimbursement requests with respect and tact and confidence
  • Always treat external and internal stakeholders with dignity and respect
  • Solid internal and external customer service skills
  • Demonstrated track record of successful behavioral health contracting negotiation skills
• Solid internal resource negotiation skills
• Exceptionally well-organized self-starter who is able to learn quickly and often on own, work with minimal supervision and keep up with workload
• Ability to: work in a very fast-paced work environment with multiple, competing priorities; follow-through with assignments and tasks is a MUST with both internal and external customers; keep up with heavy workload; learn the position and begin performing the work quickly; navigate complex, challenging external and internal stakeholder relationships without it interfering with ability to accomplish job duties and work directives in effective and efficient manner; negotiate contract language modifications with providers and work with legal counsel; manage multiple projects and assignments while juggling various internal and external conference calls and respond to providers, internal customers via email and phone on a timely basis and update fee schedules, and process rate increase requests, and issue contacts and amendments on timely basis

 

*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.

 

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.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.