Manager, Network Management - Trumbull, CT

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.UnitedHealthcare, a UnitedHealth Group company, provides network-based health and well-being benefits and services for employers and consumers nationwide. We use our strength, diversity and innovation to improve the lives of the more than 18 million people who receive our unique products and services. And our endless pursuit for excellence in everything we do extends to your career as well. Join us today for an inspired and purposeful mix of professional growth opportunities and personal rewards. Primary Responsibilities: Support the Director in leading the Network Management staff of a large to very large health plan with a complex network in achieving goals set for the department, both financial and non-financial, and ensuring that the staff is adequately prepared to perform their day to day accountabilities. Provide management support to the Director of Network Management. Manage Network Management staff resources within the Health Plan. Develop and coach Network Management staff. Participate in the development of and has direct accountability for execution of specified health plan network strategies. Assist Director in oversight of the health plan's medical cost per unit trend budget by monitoring and documenting activities related to specific strategies. Participate in the development and monitoring of a specific subset of the department SG&A budgets related to Network Management. Establish and maintain relationships with Tier 1 and Tier 2 providers according to the Relationship Management Guidelines; participates in Tier 1 provider negotiations. Establish and maintain strong working relationships with key internal and external constituencies, including RAR, Physician Data Sharing and PIM, Underwriting and Health Care Economics regarding assumptions and reporting based on unit cost changes, and the local community. Assist Director in managing the relationship with one or more of UnitedHealth Group's affiliated companies, including Uniprise, UBH, UHN, URN, Optum, Extended Markets, etc., as delegated by Director. Establish and maintains strong collaborative relationships with UnitedHealth Networks leadership and regional Network Management leadership. Act as Network Management liaison to other operational areas within the health plan. Assist Director to ensure ensuring Network Management compliance with specific requirements relative to regulatory, accreditation (NCQA and JCAHO) and operational performance, as delegated by Director. Collaborate with Director of Network Management and Care Coordination leadership in the design, implementation and ongoing delivery of physician data sharing information. Assist the Director in managing the provider appeals process by triaging and resolving specific cases in collaboration with Care Coordination, Quality Assurance, Regulatory Compliance and other operational areas of the health plan. Oversee the development of provider educational materials and communications. Participate in Sales Finalists presentations, as requested. Assist Director in creation and monitoring of specific initiatives for the health plan's Medical Expense Action Plan related to cost per unit issues as assigned by the Director; participate in the creation of the annual cost per unit budget and any interim re-forecasting on a monthly basis. Facilitate the implementation and ongoing use of CGC and other corporate initiatives within the health plan. Represent Network Management at local and regional meetings when requested. Participate in CGC work groups as needed/requested. Monitor and influence claim resolution processes performed by Uniprise. Monitor and influence PIM processes.Qualifications: Three to five years in a network management role handling complex network providers with accountability for business results. Bachelors degree in business, health care management or related field, or equivalent experience. Excellent knowledge of health care industry. Create and manage a medical cost and administrative budget. Contribute to the development of product pricing. Interpret and take action on trend reporting. Knowledge of Medicare reimbursement methodologies (Resource Based Relative Value System, DRG, Ambulatory Surgery Center Groupers, etc.). Utilize financial modeling and analysis in making rate decisions. In-depth knowledge of the contracting process. Problem Solving skills Systematically analyze problems Draw relevant conclusions Devise appropriate courses of action Excellent verbal and written communication skills Speak clearly and concisely Conveying complex or technical information in a manner that others can understand Understand and interpret complex information from others Strong negotiation skills Gain acceptance from others of a plan or idea Achieve a mutually beneficial outcomeDiversity creates a healthier atmosphere:  equal opportunity employer M/F/D/V.