Experience Inc. Jobs

Job Information

UnitedHealth Group Network Medical Cost Consultant, OptumCare Nevada - Las Vegas, NV in Las Vegas, Nevada

There comes a point when you’re ready to take off the training wheels and start guiding others. If that’s where you are today, let’s talk about where you can be tomorrow with our leading, global health care organization. UnitedHealth Group is driving ever higher levels of sophistication in how provider networks perform, costs are contained and quality and access expand. Here’s where you come in. You’ll use your knowledge of process management and contractual analysis to help us drive innovations in our global operations. As you do, you’ll discover the resources, backing and opportunities that you’d expect from a Fortune 6 leader.

Primary Responsibilities:

  • Help develop and drive provider performance improvement strategies and medical cost containment programs

  • Conduct special projects that directly impact the operational and financial performance of network management

  • Analyze medical utilization rates across physician, hospital and ancillary service lines or individual providers

  • Provide technical and analytical support to field markets to assist in the development of sophisticated and complex analysis of network utilization

  • Serve as a key resource on complex and / or critical issues

  • Review work performed by others and provide recommendations for improvement

  • May lead functional or segment teams or projects

This will challenge you as it is a highly visible position. Your role will help collect and analyze complex data from multiple sources and be charged with translating it into a meaningful story for decision makers.

Required Qualifications:

  • 5+ years of experience consulting with, or working within, a managed care organization or health insurer

  • 3+ years project management experience

  • 3+ years experience with network analysis

  • 2+ years experience with reimbursement methodologies such as RBRVS, ASC groupers, APCs, per diems, case rates, DRGs, fee schedules and AWP

  • Problem solving skills, including the ability to systematically analyze complex problems, draw relevant conclusions and successfully devise / implement solutions

  • Advanced proficiency with MS Excel

Preferred Qualifications:

  • Undergraduate degree

  • Experience in network development / contract management, network evaluation and/or underwriting role

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)

Diversity creates a healthier atmosphere: OptumCare and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Managed Care, health care, capitated, claims, analyze, analytics, FFS, medical cost analysis, contract, network, utilization, rates, RBRVS, ASC, APC, DRG, fee schedules, AWP

DirectEmployers