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Healthcare Network Program Manager - Hospital Performance Based Compen - Eden Prairie, MN

Company: UHG
Job type: full-time
Category: Hospital, Health Care


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Job description

Job 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) This position is part of the Network Strategy and Innovation team supporting the Hospital Performance Based Compensation (PBC) Program. This initiative is a critical component of UnitedHealthcare's hospital network strategy in response to health care reform, customer demands, clinical quality and medical cost needs, and regulatory requirements. This position serves to support UHN's work in this important area by working with supporting functional areas (Health Services, Health Care Economics, OptumInsight, and Commercial and governmental markets) to develop and maintain the PBC infrastructure and supporting tool kit as well as work with the national, regional, and local network management teams to successfully negotiate the Hospital PBC Program provision into hospital contracts. Primary Responsibilities: The primary functions of this position are to assist with the building, management, coordination, training and reporting on all components of the Hospital PBC program. This position will be a liaison between the operations and the contracting staff to ensure adequate training and assistance during negotiations and deployment of the program. To be successful, this individual will need to interface with internal people throughout UnitedHealth Group and occasionally externally with hospitals and other providers. The components of the Hospital PBC program include the following: * Measures: Collaborate with Health Services, Health Care Economics, and OptumInsight to assist to develop, maintain and review quality and efficiency and operational performance measures for the program. Measures will be updated and refined over time to remain current with industry initiatives as well as promote industry innovation and will be created for new PBC programs supporting other provider types (for example ASCs) and other products (Medicare and Retirees and Community and State) as required * Reporting: Collaborate with Health Care Economics and OptumInsight to develop and maintain both internal and external report formats and reporting capabilities. Collaborate with OptumInsight and associated areas to develop and maintain reporting on the online portal for hospitals where they have independent access to be able to review data on a timely basis so they can focus on improving their performance on Hospital PBC measures * Training: Assist in the development of training materials and conduct training for all internal personnel impacted by the program (Network Management, Healthcare Economics, Sales, Health Services, etc) * Program Standards: Perform reviews on all new contracts to ensure compliance with program requirements and supportability. Coordinate review and responses to facility questions and reconsideration requests. Develop and maintain process to impact program retention through renewal activities * Program evaluation: Develop and maintain standard reports to track the progress of the program against the established annual goals. Utilize reports to identify opportunities for improvement in medical cost savings and report findings. Evaluation of progress will be reviewed with senior management on a regular basis. Issues impeding the success will need to be identified along with mitigation plans Required Qualifications: * Undergraduate degree or equivalent work experience * 8 years of experience working with a managed care organization, health insurer, or consultant in a network management/contract management role, such as contracting, provider services, etc. * 5 years of experience in data analysis * 2 years project management or project lead experience * Advanced level of proficiency with all physician/facility/ancillary contract reimbursement methodologies * Ability to convey complex or technical information in a manner that others can understand * Excellent communication skills, including ability to communicate effectively with various levels of leadership * Advanced level of proficiency in MS Office (Excel and PowerPoint) * Intermediate familiarity with UB claims data elements * Ability to travel nationwide occasionally, overnights Preferred Qualifications: * Experience working with claims systems * Experience working with Emptoris Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across t


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