Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)
The Network Pricing Consultant supports and validates Provider Network (pharmacies) contracting and unit cost management activities through financial and network pricing modeling, analysis, and reporting. Network Pricing Consultants conduct unit cost and contract valuation analysis in support of network contracting negotiations and unit cost management strategies. Responsibilities also include managing unit cost budgets, target setting, performance reporting, and associated financial models.
This team is responsible for making sure that we are complaint with state MAC laws regarding pricing and appeals. They meet with the Regulatory Department and find ways to operationalize state law requirements. They also generate reports and deal with escalated complaints from states DOI.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Serve as a key resource on complex and / or critical issues
- Collaborate with others to develop policies and procedures and implement solutions that ensure adherence with applicable laws and regulations
- Review and assess regulatory requirements applicable to business units
- Maintain proper documentation of policies and procedures, process flows, SOPs, Job Aids, etc.
- Develop pricing models for provider reimbursement in response to legislated requirements
- Provide business rules and requirements for IT development of system tools to support new processes and/or enhancements
- Design and create various internal and external reporting
- Solve complex problems and develop innovative solutions
- Anticipate customer needs and proactively develop solutions to meet them
- Perform complex conceptual analyses
- Review work performed by others and provide recommendations for improvement
- Forecast and plan resource requirements
- May lead functional or segment teams or projects
- Provide explanations and information to others on the most complex issues
- Motivate and inspire other team members
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.
- Undergraduate degree
- 5+ years of analytical experience in financial analysis, healthcare pricing, network management, healthcare economics, or related discipline
- 3+ years of experience with provider payment methodologies and healthcare products
- Intermediate level of proficiency in performing financial impact analysis, risk management, and data manipulation
- 2+ years of experience in creating and using financial modeling tools, spreadsheets, and information acquisition tools
- 2+ years of experience in documenting policies and procedures, workflows, and tracking critical timelines
- Solid written and verbal communication skills
- Experience in interpreting and reviewing financial modeling results to evaluate financial impact and develop forecasts
- Expert level proficiency in MS Excel (formulas, macros, pivot tables, run calculations, create pricing models, create reporting, manipulate data, etc.)
- Intermediate Level Proficiency with SQL (pull, sort, filter and manipulate data, code, create reporting, etc.)
If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
- Ability to prioritize, coordinate and manage multiple tasks in a fast-paced environment
- Flexible and able to adapt to new processes
- Self-motivated, self-driven and detail-oriented
- Knowledge of MS Access and Tableau
- Experience with Regulatory, Legal, Compliance or Contracting
Careers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you’ll fill far more than prescriptions. As a member of one of our pharmacy teams, you’re empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)
The salary range for Colorado residents is $64,800 to $116,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.
*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.
Job Keywords: Network Pricing Consultant, Finance, Healthcare, Medical Field, Optum, OptumCare, OptumRx, UnitedHealth Group, UHG, Irvine CA, California, Schaumburg, IL, Illinois, Eden Prairie, MN, Minnesota, Overland Park, KS, Kansas, Telecommute, Telecommuter, Telecommuting, Work from home, WFH, Work at home, Remote