Senior Director Payor Contracting | Remote

An organisation is searching for a Senior Director Payor Contracting, please see some of their job details below.

Primary Responsibilities:
• Recommends, develops, and executes strategic long-range planning as it relates to contracted payors and product participation in support of the market and enterprise strategic mission, philosophy, and goals
• Evaluates and makes recommendations for business development and expansion opportunities within assigned territories
• Oversees the implementation of all expansion projects within assigned territories
• Utilize applicable financial tools and reports (e.g., internal financial models; external reports) to evaluate performance of current contracts.
• Balance financial and operational impact of contracts to providers, members, payors, Optum Care Network, and different customer groups when developing and/or negotiating contract terms
• 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.
• Evaluates market rates and payor performance to establish rate requests and negotiation strategies
• Communicates proposed contractual terms with payors and negotiate mutually acceptable agreement
• Monitors and/or oversee payor performance and industry trends to identify opportunities to refine, develop, and/or implement market strategies
• Represents department in internal meetings (e.g., medical management; M&R; C&S, growth, and acquisitions) to gather relevant information, present/recommend solutions, and provide updates on results/decision/activities
• Develops and/or implements contracting strategies to support new benefits designs and plans

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 related experience in managed care contracting with an understanding of managed healthcare or equivalent combination of education and experience
• 2+ years of experience managing a team
• Extensive understanding of clinic financials with the ability to analyze operations and continually implement efficient operational processes
• Proven solid business acumen and proven strategic leadership skills
• Ability to travel up to approximately 25% within assigned market and to California corporate office for meetings

Preferred Qualifications:
• California Market Managed Care Experience
• Understanding of California insurance rules and regulations as it relates to managed care contracting
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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