Outpatient Behavioral Health Contracting - California - Telecommuter
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)
The more you do, the more you learn. And as you learn you find new doors opening that challenge you to bring your best. This Outpatient Behavioral Health Contracting role with UnitedHealth Group will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. We’re building better, more effective provider networks every day. In this role, you’ll use your strong contracting experience to build and maintain our behavioral health provider networks. As you do, you’ll discover the impact you want and the resources, backing and opportunities that you’d expect from a Fortune 5 leader.
If you reside in California, you will have the flexibility to telecommute* as you take on some tough challenges.
- Telecommute position and ideally will reside in California. Some minor in California will be required
- Must have COVID card documenting all COVID vaccinations and boosters are complete prior to hire
- Serve as the subject matter expert for commercial, Medicare, and Medi-Cal outpatient behavioral health provider/agency/group contracting in California and any other states you are assigned
- Conduct provider outreach for outpatient behavioral health provider/agency/group network expansion
- When interacting with providers, manage provider expectations about timelines for contracting, credentialing, reimbursement levels and methodology, site audits, and the like
- Develops and maintains positive relationships with external (e.g., behavioral health providers, behavioral health groups, behavioral health agencies/community mental health agencies/federally qualified health clinics, tribal government and other tribal organizations, government agencies) and internal customers
- Assemble provider agreements consisting of base agreements, appendices and addendums, fee schedules, supervisory protocols, and related documents
- Issue provider applications, agreements, amendments and related documents to providers
- Gather completed provider applications and other documents that accompany the application, other documents required by state law and/or company policy; review these documents for completeness, accuracy, organize, and submit documents for credentialing
- Coordinate and follow-up with Optum Provider Relations Advocates to ensure timeliness of submission of applications and related documentsContinually engaged with prospective and existing external customers and internal customers; promptly responds to external and internal customer inquiries; responsible for remaining en
- gaged with external and internal customers until the job is complete; responsible for proactively keep external and internal customers updated about status of requests; communicating with external and internal customers via phone and email and using each appropriately to develop strong working relationships, this includes being prepared for scheduled calls with customers and writing professional communications
- MUST promptly acknowledge receipt of emails and voice mails
- Actively participate in Western US Outpatient Behavioral Health Contracting Team Meetings
- Serves as a positive member of the internal network team community
- Team player; Always willing to step-up and help team members as appropriate; respectful of team members and chain of command
- Understand health plan provider contracts and contract language, terms and conditions and occasionally review provider’s proposed language changes and occasionally draft counter language for review by supervisor and legal counsel)
- Models personal responsibility, dependability, reliability and flexibility in being able to meet the needs of the team and business; accepts responsibility and accountability for actions
- Continually learns and retains/absorbs knowledge, information and skills to perform the position as you work independently
- Models integrity and honesty; behaves in an honest, fair, and ethical manner; if says work is complete, it truly is complete and accurate according to standards. Takes the higher road when it comes to conflict
- Models stewardship of recourse and documents; is efficient and effective with use of work time; archives and saves fully executed agreements, current fee schedules and related documents in appropriate locations; responsible with public (Medicaid and Medicare) and private funds when negotiating reimbursement in provider agreements
- Significant hands-on experience with behavioral health provider contracting in the California commercial, Medicare and Medi-Cal market that demonstrates a history of success with:
- payment methodologies,
- geographic service areas
- fee schedules,
- payment appendices,
- providers, behavioral health agencies, and groups,
- California regulatory and legal and political dynamics and factors at play that are truly unique to the California provider and insurance market
- Report to the Director of Outpatient Behavioral Health Contracting of the Western US
- Keep Director of Outpatient Behavioral Health Contracting of Western US and Senior Outpatient Behavioral Health Contracting Manager Updated on timely basis about provider network development, contracting developments, rate negotiations, rate increase requests, emerging issues and the like
- Ability to learn and use proprietary and other software programs for sending, updating and storage of provider/agency/group contracts and numerous fee schedules and related contractual documents
- Develop, update and maintain numerous fee schedules
- Email and phone communication with internal and external customers throughout each day
- Ability to work in fast-paced work environment with multiple competing priorities and people from multiple functions within company and multiple external customers and ability to re-prioritize as work and customer deadlines and demands change throughout day and week
- Exceptional verbal (telephone, video conferencing and in-person) and written communication skills (emails, memos and letters)
- Ability to use tact and diplomacy when appropriate
- Ability to use superior discernment in stakeholder and provider communications
- Ability to communicate effectively, professionally and comfortably with staff at multiple levels and from multiple functional areas and from various professional fields within provider/agency/group organizations (e.g., CEOs, CFOs, COOs, Contract Directors, Clinical Directors, Medical Directors, Program Directors, and various types of direct service professionals)
- Ability to communicate with regulators
- Ability to engage in light travel within the markets this position is responsible as needed
- This is a salaried position and will require more than 40 hours per week at times to keep up with work or complete work assignments
Are you ready for a challenge? You’ll be part of a performance driven, fast paced organization that is serving multiple markets and you’ll be charged with educating and building relationships with providers to evolve ongoing processes and programs.
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.
- High school diploma or equivalent work experience
- 4+ years of health care/managed care experience
- 2+ years of behavioral health provider contracting experience (actually preparing, negotiating and issuing contracts to providers)
- 1+ years of experience with commercial, Medicare and Medicaid programs and regulations
- 1+ years of experience:Working at a health plan / managed care organization contracting with behavioral heala
- 1+ years of experience:Negotiating behavioral health contracts between behavioral providers and health plans / managed care providers
- 1+ years of experience:Interacting with behavioral health professionals and/or behavioral health organizational leaders when working with prospective providers
- Proficiency using Excel to develop and analyzing behavioral health fee schedules using Excel
- Proficiency with MS Word, Excel, PowerPoint and Access
- Live in California; light travel to various within the market will be required on occasion
- Ability to show up to work on time, attend meetings on time, and be a productive team member
- Ability and willingness to write in complete sentences, use correct grammar, use proper punctuation, use correct words, and use correct spelling in written communications and contract documents
- Anticipate light travel to various cities throughout the state in 2023. MUST have COVID card documenting current COVID vaccinations and boosters prior to hire
- Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
- Undergraduate degree, preferably in business administration, public administration, healthcare administration, public health, law, social services or related field. Master’s degree in one of these fields a significant plus.
- Extensive experience negotiating reimbursement increase requests of complex fee schedules for large health systems
- Experience negotiating non-standard payment methodologies and value-based contracting
- Knowledge Maintaining complex provider outpatient behavioral health fee schedules
- Experience in behavioral health facility contracting
- Proficient with Excel, and previous experience developing, updating a health insurance regulatory framework and environment, including federal and state laws (e.g., Knox-Keene, California Code) and federal and state regulations (California Code of Regulations), including California Department of Insurance (CDI) and California Department of Managed Care (DMHC), California Department of Health Care Services (DHCS) requirements, processes and organizational structures.
- Working knowledge of California geography and map, and provider markets---urban, suburban, rural and frontier throughout the state.
- Knowledge of communities, towns and cities throughout California. Understand how the geographic location of these communities, their transportation resources and other factors impact enrollee access behavioral healthcare - and how this will drive our provider recruitment efforts.
- Experience and knowledge of Optum software programs and analytical tools including but not limited to:
- OHBS FACETS
- DocuSign or AdobeSign
- ePUFs (electronic provider update forms)
- SURE Reports
- FAT (Financial Analysis Tool)
- Fee Schedule Pricing Profiles
- Knowledge of Medicaid, Medicare and CMS regulations
- Outgoing work personality
- Ability to verbally engage and develop a rapport with external and internal customers you have not previously met or worked with (regardless of their personality and disposition when interacting with us)
- Ability to draft engaging, personable and professional email communications that engage external customers, particularly providers, to take action when you have not previously communicated with before
- Solid emotional intelligence when selecting communication tools and mediums - especially ability to know when and how to use video conferencing, telephone and/or email, and to foresee consequences of language in written communications
- Proactively take initiative to do own research to look up information that can be readily found internally or externally
- Ability to learn and become familiar with contents of contract documents and understand them quickly
- Act responsibly, take accountability for actions and be dependable
- Act with integrity, be honest, and behave in an honest, fair and ethical manor.
Other important experience:
- Exceptional verbal and written communications
- Exceptionally well-organized self-starter who is able to learn quickly and often on own, work with minimal supervision and keep up with workload
- Ability to interact and communicate with individuals in a variety of positions (external customers: CEOs, CFOs, COOs, Contract Directors, and others; internal customers: Contract Managers, Provider Relations Advocates, Directors, Vice Presidents, and individuals from a wide variety of functional areas)
- Ability to work in a very fast-paced work environment with multiple, competing priorities
- Ability to follow-through with assignments and tasks is a MUST with both internal and external customers
- Ability to keep up with heavy workload
- Ability to learn the position and begin performing the work quickly
- Ability to work with providers/agencies/groups and tell them “no” to various contract and reimbursement requests with respect and tact and confidence
- Ability to navigate complex, challenging external and internal stakeholder relationships without it interfering with ability to accomplish job duties and work directives in effective and efficient manner
- Ability to negotiate contract language modifications with providers and work with legal counsel
- Ability to manage multiple projects and assignments while juggling various internal and external conference calls and respond to providers, internal customers via email and phone on a timely basis and update fee schedules, and process rate increase requests, and issue contacts and amendments on timely basis
- Treat external and internal stakeholders with dignity and respect
- Solid internal and external customer service skills
- Solid negotiation skills
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.