Treatment for an injury may require a variety of services. Optum has the solution to help manage them all. We call this Total Care Management. Built from a foundation of Network Management, Clinical Care Management and Client Support & Tools, Total Care Management helps clients address every component of a claim. The coordination of our pharmacy, ancillary and medical services, along with settlement solutions, provides multiple benefits to clients. Optum’s Workers’ Comp and Auto No-Fault Division (OWCA), a UnitedHealth Group company, helps our clients achieve optimal financial outcomes through our programs to manage pharmacy, PPO and ancillary spend. We are the leading provider of workers’ comp and auto no-fault medical care management services. Our unparalleled scale, breadth of expertise, and depth of analytic insight make it easier for clients to work smarter and improve the predictability of outcomes while advancing the safety and efficacy of care. We have an elite team of 2000+ experienced professionals with a customer focus geared toward best in class service. This is a place like no other and where you’ll do your life’s best work.(sm)
As a Network Pricing Consultant, you will support and validate Provider Network contracting and unit cost management activities through financial modeling, analysis, and reporting. This role will provide the opportunity to work on physician, hospital and ancillary facility go out pricing that will give us the competitive edge against our competition. Responsibilities will include managing unit cost budgets, target setting, performance reporting, and associated financial models. In this role you will be supporting our Network Contract Managers and Network Contract Coordinator. Seeking someone with experience in pricing reimbursement rates for providers; someone who can evaluate network performance metrics (gap analysis - where we can improve our networks). Identify provider coverage adequacy within areas and help the team drive where we need to broaden our network footprint.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Perform modeling and data analysis of provider contracts
- Perform data mining to resolve issues
- Communicate modeling results both written and verbally to internal customers
- Track monthly unit cost projections
- Anticipate customer needs and proactively develop solutions to meet them
- Work collaboratively on team projects
- Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management
- Be a back-up resource where we are single threaded (i.e. examining network hierarchies by state)
- Evaluating the PPO customer base (i.e. carriers, TPAs, etc) and identifying patterns of the business that influence the buying of PPO services and what will contribute to customer retention
- Passion for customer service
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.
- High school graduate / GED
- 3+ years of analytical experience in financial analysis, healthcare pricing, network management, healthcare economics, or related discipline
- 1+ years of experience specifically in the Workers’ Comp and / or Auto areas
- Intermediate Excel skills (edit/create spreadsheets, work with formulas, sorts and filters, pivot tables, etc.)
- Intermediate or better proficiency working with other programs in MS Office Suite (i.e. Word, PowerPoint, Outlook, etc.)
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
- Bachelor degree
- Experience working with data visualization programs, such as Tableau or Microstrategies
- Experience with provider payment methodologies and healthcare products
- Solid written and verbal communication skills
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
The salary range for Colorado residents is $64,800 to $116,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.
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