Behavioral Health Contracting - California and Western United States - Remote

Improve the lives of others while Caring. Connecting. Growing together.Behavioral Health Contracting – California and Western United States – Remote (2355870)Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.Primary ResponsibilitiesWork Pacific Standard Time (PST) to collaborate with the behavioral health provider community during their business hours (8 am to 5 pm PST) in California and other Western U.S. states, including but not limited to Idaho, Nevada, and Utah.Recruit and contract with high‐quality, competitive behavioral health network providers (outpatient and facility) to meet access, availability, and regulatory standards.Update systems for California and other state commercial, Medicare, and Medicaid contract negotiations and network changes, including fee schedule negotiations and development.Conduct end‐to‐end contracting processes for new programs and products, and serve as a contracting subject‐matter expert for assigned states, lines of business, and programs.Provide backup contracting support for other assigned states.Attend internal and external meetings with state customers, regulators, providers, and health plan stakeholders.Lead interface and leadership roles with health plan leadership, account managers, internal behavioral health functional leaders (finance, underwriting), provider leadership, and state regulators.Collaborate with behavioral health economics, legal, finance, and underwriting to develop, maintain, and monitor provider payment arrangements.Present and report verbally and in writing to state regulators via conference calls on Medicaid contracting, provider contracting, network adequacy, and related topics.Work with behavioral health CPT, DRG, per diem, and RBRVS reimbursement methodologies.Use discernment and decision‐making abilities to support upper‐level management and state regulators.Communicate clear expectations to providers regarding timelines for contracting, credentialing, reimbursement levels, methodology, and audits.Maintain primary network contracting relationships with external providers, groups, agencies, and government entities, and coordinate application and credentialing documentation.Assemble provider agreements, fee schedules, and related documents, and coordinate with provider relations advocates for timely submission.Respond promptly to internal and external customer inquiries, keeping stakeholders informed of status, and communicate professionally via phone and email.Understand provider contracts and draft counter‐language when necessary in collaboration with supervisors and legal counsel.Model personal responsibility, dependability, reliability, and flexibility; accept accountability for actions.Act with integrity and honesty, ensuring work completion to standards and employing ethical conflict resolution.Use stewardship of resources, efficiently archiving executed agreements and fee schedules in appropriate locations.Report to the Director of Outpatient Behavioral Health Contracting – Western U.S.; keep the Director updated on provider network development, contracting, rate negotiations, and emerging issues.Use proprietary software for sending, updating, and storing provider contracts and fee schedules.Participate in scheduled and ad‐hoc joint Provider Relations – Outpatient Behavioral Health Contracting meetings.Engage in a broad range of internal meetings across provider services, network strategy, legal, contracting, project management, economics, finance, underwriting, clinical, compliance, claims, consumer affairs, IT, and sales.Communicate throughout each workday via email and phone with internal and external customers, including supervisors and team members.Work in a fast‐paced environment with multiple competing priorities and respond to internal and external customers as needed.Respond during telecommuter office hours (8:00 am to 5:00 pm PST) and complete assignments that may exceed 40 hours per week.Required Qualifications3+ years of health‐care/managed‐care experience, including: Hands‐on experience with medical, facility, and/or behavioral health provider contracting in California.Work at a health plan/managed‐care organization contracting with outpatient and facility providers.Negotiation of behavioral health contracts for commercial, Medicare, and/or Medicaid lines of business.Use of outpatient and facility reimbursement codes and methodologies.Interaction with behavioral health professionals and leaders when engaging prospective providers.Solid knowledge of California geography, counties, cities, and provider markets, as well as Western U.S. behavioral health provider markets.Proficiency using Excel to develop and analyze behavioral health fee schedules.Proficiency with MS Word, Excel, PowerPoint, and Access.Understanding of health‐plan reimbursement, finance, and underwriting principles.Superior discernment in stakeholder and provider communications, with professional communication across multiple levels and functional areas.Experience contracting with providers for commercial, Medicare, and Medicaid lines of business.Preferred Qualifications2+ years of experience with two or more of the following: Collaboration with health‐plan finance or underwriting staff on provider payment strategies, fee schedules, and payment tables.Collaboration with health‐plan legal counsel on contract language modifications.Commercial, Medicare, and/or Medicaid behavioral health provider contracting experience.High proficiency in Excel for fee schedule analysis and maintenance.Behavioral health contracting experience in Idaho, Nevada, and Utah.Basic understanding of California health‐plan regulatory framework and other state Medicaid regulations.Knowledge of Medicare and CMS regulations.Exceptional verbal and written communications skills.Appropriate business demeanor in video conferences and in‐person meetings.Professional written communication tailored to audience.Tact and diplomacy in sensitive topics.Courtesy and professionalism with all stakeholders.Ability to communicate "no" with respect and confidence when appropriate.Respectful treatment of external and internal stakeholders.Solid customer‐service skills.Demonstrated track record in behavioral health contracting negotiation.Strong internal resource negotiation skills.Highly organized self‐starter able to learn quickly and work with minimal supervision.Capacity to work in a fast‐paced environment with multiple competing priorities and heavy workload.Ability to negotiate contract language modifications with providers and legal counsel, manage multiple projects, and respond to customer inquiries promptly.Compensation & Benefits Pay ranges from $72,800 to $130,000 annually, based on full‐time employment, and is influenced by local labor markets, education, work experience, and certifications. Benefits include a comprehensive package, incentive and recognition programs, equity stock purchase, and 401(k) contribution (subject to eligibility).Application Deadline The position will be posted for a minimum of two business days or until a sufficient candidate pool is collected. Job posting may close early due to applicant volume.Equal Opportunity Employment 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.#J-18808-Ljbffr