Manager of Payor Contracting - Los Angeles and Inland Empire - 2195516

Location

El Segundo, CA | United States

Job description

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.

The Manager of Payor Contracting supports the Sr. Directors of Payor Contracting in negotiating assigned agreements which benefit Optum, the healthcare professionals it represents, and the patients it serves.  This position is responsible for drafting and managing contracts, serving as an organizational subject matter expert on existing capitation agreements for the California Market, and researching and resolving payor issues.  Role will have direct reports, and require solid collaboration with multiple teams (Provider Contracting, Contract Operations, Regional Operations, UM, QM, Claims, Finance, etc).  This individual will represent Payor Contracting in interdepartmental initiatives, as assigned.

Primary Responsibilities: 

• Tracks renewals, and leads contract negotiations, as assigned.  This will include capitated health plan agreements with HMO’s for commercial and Medicare lines of business
• Circulates draft contract terms/language to various internal departments, including Legal, Finance, Claims, Quality and Medical Management teams for review & approval
• Applies knowledge of healthcare delivery system or management service organization (MSO)/IPA operations, managed care, healthcare laws, and the Knox-Keene Act in assisting with the development of contracting strategies
• Develops, implements, and manages the Division of Financial Responsibility (DOFR) documents for assigned health plan contracts
• Communicates with internal DMHC Engagement team to ensure timely filing
• Answers and/or resolves urgent inquiries from health plans or internal departments in a timely manner
• Establishes good working relationships with health plan representatives, as well as internal teams
• Develops tools (e.g., dashboards, grids, tables, summaries) as needed to provide organizational leadership key contract data
• Team development (coaching and mentoring of team)
• Project Management – various ad-hoc requests with short turnaround time
• Other duties as assigned

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. 

Years of post-high school education can be substituted/is equivalent to years of experience

Required Qualifications: 

• 5+ years of experience in managed care contracting/contract administration
• Experience with capitation, and risk sharing arrangements
• Experience with government programs (Medicare, Medi-Cal)
• Experience working with health plan counterparts
• Advanced MS Word capabilities: find & replace, redlining, comment insertion, track changes and document compare
• Proficient in MS Excel and PowerPoint software
• Individual must be able to develop Power Point presentations and basic formatting with utilization of databases and spreadsheets
• Hybrid role (remote base and office based in our El Segundo or Ontario, CA office locations)

Preferred  Qualifications :

• Health plan or provider group/IPA experience
• Supervisory experience 
• Solid teammate management experience
• Experience with  understanding financial models analyzing health plan agreements
• Proven high attention to detail and personal organization
• Proven ability to manage a team with a wide range of skills and professional developmental needs
• Proven ability to make independent decisions
• Proven ability to interact with health plan partners, providers, and teammates
• Proven ability to change thought patterns quickly
• Proven ability to multitask

California Residents Only: The salary range for California residents is $85,000 to $167,300 per year . Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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 .  

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.

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