Manager Network Programs


What makes your career greater with UnitedHealth Group? Growth opportunities among the variety of product lines and making an impact on the healthcare system ensures it will always be challenging and exciting. The Manager of Network Program is responsible for:

-Initiate and lead negotiations with hospitals to obtains all ICD-9 codes to meet the Federal regulations that require Medicare Advantage organizations to ensure that complete and accurate coding is represented in the risk adjusted claim submissions to CMS
- Manage all facets of relationships the geography-specific set of Hospitals yielding a geographic-specific broad access that achieves all ICD-9 data capture objectives to performance and yields an affordable and predictable product for customers.
- Develop and execute ICD-9 data capture strategies that directly impact financial performance of customers.
- Accountable for all alternative ICD-9 data submission development and management activities with hospitals in accordance with Ingenix standards and key process controls to achieve market/region/division/company/customer objectives.
- Leading and implementing ICD-9 data capture strategy, analyses, and language/cost negotiations for a specific set of hospitals.
- Work with and involve relevant stakeholders (regional and corporate network management, internal customers, external customers, etc.) in negotiation decisions impacting legal or regulatory requirements, contract standards and data capture targets.
- Monitor geography-specific unit RAF performance and improve competitiveness, breadth, and stability of customer.
- Develop and successfully implement geography-specific ICD-9 data capture improvement plans for hospitals.
- Determine data adequacy, comprehensive and compliance of the hospitals ICD-9 data submission in accordance with geography-specific targets.
- Ensure integrity of ICD-9 data capture with Ingenix policies and compliance with pertinent regulatory guidelines.
- Accountable for relevant components of provider relationship management, including leading meetings, as necessary, and provider outreach/communication.
- Perform and monitor activities related to the ICD-9 data submission process and engage appropriate service organization for issue resolution.
- Provide advice/guidance/recommendations to senior management regarding health care costs; cost savings opportunities; best practices; provider performance issues; and ICD-9 data expansion.
- Maintain highest personal/professional integrity and enforce Principles of Integrity and Compliance.

- Four to eight years in a network development/contract management role.
- Bachelor's degree in business, health care management, or related field.
- Intermediate to Advanced MS Excel, MS Access experience related to data analysis.
- High degree of proficiency in utilizing and interpreting financial models and data adequacy analyses.
- Strong knowledge of ICD-9 codes, clearinghouses, reimbursement methodologies and clear understanding of Medicare, Data base knowledge and claims processing guidelines.
- Experience applying financial analyses, hospital bill audit results and contract standards to the development of Requests for Proposals and ICD-9 data capture strategies.

Problem solving skills:
- Systematically analyze complex problems
- Draw relevant conclusions
- Successfully devise/implement appropriate solutions

Operating Efficiency:
- Implements and operates in compliance with Ingenix process controls and standards.
- Facilitates value to customer and business partners.
- Multi-task, shifting back and forth effectively among multiple activities.

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
- Speak in both individual and group settings
- Negotiation skills
- Influencing skills

OptumInsight is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

OptumInsight is one of the largest and fastest growing health information companies. We specialize in improving the performance of the health system by providing analytics, technology and consulting services that enable better decisions and results. We integrate workflow solutions that deliver data in real-time, and create actionable insights - processing health information that relates directly to and affects one in four patients in the U.S, one in every three Medicaid dollars and one in every five emergency room visits. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation Performance.

What can YOU do with the right information? At OptumInsight, the possibilities and the impact are limitless. No matter what your role is at OptumInsight, you'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever. It's always fresh. It's always exciting. And it's never been more important.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.