Director Payor Contracting - Remote in California

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 Director of Payor Contracting supports the VP and Sr. Director 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 leading assigned health plan negotiations, drafting and managing contracts, serving as an organizational subject matter expert on existing FFS and risk agreements for the California Market, and researching and resolving payor issues. Role will not have direct reports but will require extensive collaboration with multiple teams (Provider & Institutional Contracting, Contract Operations, Regional Operations, UM, QM, Claims, Finance, Analytics, etc). This individual will represent Payor Contracting in interdepartmental initiatives, as assigned.

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

Primary Responsibilities:

• Leads contract negotiations, as assigned. This may include, but is not limited to, risked based agreements, fee-for-service negotiations, pay for performance programs, and ACO agreements with health plans
• Manages contractual relationships with payers and internal stakeholders
• Reviews health plan contract language, and is familiar with payor, medical group/IPA, and hospital/ancillary contract language and reimbursement mechanisms
• 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, IPA operations, managed care, healthcare laws in assisting with the development of contracting strategies
• Answers and/or resolves 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
• Utilize applicable financial tools and reports (e.g., internal financial models; external reports) to evaluate performance of current contracts
• Interacts and consults with Network Pricing team to evaluate different financial arrangements and to identify and recommend applicable payment methodologies (e.g., FFS; capitation; Value-Based Care; Pay for Performance) to maximize value for stakeholders
• Ensures compliance and consistent contracting across the enterprise
• 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.

Required Qualifications:

• 5+ years of experience in managed care contracting/contract administration
• Direct experience leading health plan/provider negotiations
• Experience with financial models analyzing health plan agreements
• Experience with government programs (Medicare, Medicaid, and Marketplace/Exchange)
• Knowledge of and experience working in the California Managed Care Market
• Advanced MS Word capabilities: find & replace, redlining, comment insertion, track changes and document compare
• Proficient in MS Excel and PowerPoint software

Preferred Qualifications:

• Experience with capitation, DOFRs, and risk sharing arrangements
• Understanding of California insurance rules and regulations as it relates to managed care contracting
• Expertise in provider group/IPA operations and composition
• Proven ability to make independent decisions
• Proven ability to change thought patterns quickly
• Proven high attention to detail and personal organization
• Proven ability to multitask

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

The salary range for this role is $106,800 to $194,200 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.

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.