Sr. Network Pricing/Capitation Consultant - Remote
Company: UnitedHealth Group
Location: Cypress
Posted on: May 16, 2025
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Job Description:
At UnitedHealthcare, we're simplifying the health care
experience, creating healthier communities and removing barriers to
quality care. The work you do here impacts the lives of millions of
people for the better. Come build the health care system of
tomorrow, making it more responsive, affordable and equitable.
Ready to make a difference? Join us to start Caring. Connecting.
Growing together.
Can we all can agree that the quality of health care is marching
forward and upward with great momentum? Yes. But it's not just
quality of care. The entire system is becoming more efficient and
effective thanks to companies like UnitedHealth Group and people
like you. Here's your opportunity to use your expertise in new ways
as you strike the balance between health care costs and resources.
Performing unit cost and contract valuation analysis, you'll ensure
that healthcare contracts are priced accurately and fairly for all
involved. As you do, you'll discover the impact you want and the
resources, backing and opportunities that you'd expect from a
Fortune 4 leader.
This position supports and validates Provider Network (physicians,
hospitals, pharmacies, ancillary facilities, shared/full risk
delegation, etc.) contracting and unit cost management activities
through financial modeling, analysis of utilization, and reporting.
Conducts unit cost and contract valuation analysis in support of
network contracting negotiations and unit cost management
strategies. Manages unit cost budgets, target setting, performance
reporting, and associated financial models.
You'll enjoy the flexibility to work remotely * from anywhere
within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Support network pricing strategies and tactics, in collaboration
with local network field leaders and network managers
Analyze financial impact of provider contracts (e.g., facility;
physician; ancillary)
Analyze financial impact of corporate initiatives (e.g., policy
changes; healthcare affordability) or external regulations (e.g.,
healthcare reform)
Analyze payment appendices to provide options for various
contracting approaches and methodologies
Communicate results of financial impact and analysis to appropriate
stakeholder groups (e.g., Network Management; Network Pricing
leadership)
Conduct financial and network pricing modeling, analysis and
reporting
Perform unit cost and contract valuation analysis in support of
network contracting negotiations and unit cost management
strategies
Lead large, complex projects to achieve key business objectives
Influence pricing strategies and rate development by highlighting
opportunities for improvement or protecting favorable rate
structures
Strategize rates or contract methodology with network management to
create optimal contract
Review competitive analysis to identify appropriate pricing rate
for provider
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.Required
Qualifications:
8+ years of analytical experience in financial analysis, healthcare
pricing, network pricing, healthcare economics or related
discipline
5+ years of experience with provider payment methodologies and
healthcare products
5+ years of experience in creating and using financial modeling
tools, spreadsheets and information acquisition tools
Expertise in financial impact analysis, risk management and data
manipulation
Experience with provider capitation, both diagnostic
risk-adjustment and age/sex adjusted rate banding
Experience in interpreting and reviewing financial modeling results
to evaluate the financial impact of contract changes and develop
forecasts
Presentation experience to internal or external stakeholders or
customers
Expert level proficiency in MS Excel
Proven solid interpersonal, collaboration, negotiation and
communication skills
Proven excellent communication skills, both written and verbal
Proven ability to manage multiple projects simultaneously and meet
deliverable deadlines
Proven ability to research and solve problems independently
Preferred Qualifications:
Experience in MS Access, SAS, SQL, R, or Python
Experience with advanced statistical functions for financial
modeling
Experience with medical coding (CPT, MSDRG, REV, ICD-10, etc.)
Knowledge of Commercial, Medicare, and Medicaid PPO and HMO revenue
and expense, as well as delegation financial modeling
*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy
The salary range for this role is $89,800 to $176,700 annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. In addition to your salary,
UnitedHealth Group offers benefits such as, a comprehensive
benefits package, incentive and recognition programs, equity stock
purchase and 401k contribution (all benefits are subject to
eligibility requirements). No matter where or when you begin a
career with UnitedHealth Group, you'll find a far-reaching choice
of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2
business days or until a sufficient candidate pool has been
collected. Job posting may come down early due to volume of
applicants.
At UnitedHealth Group, our mission is to help people live healthier
lives and make the health system work better for everyone. We
believe everyone-of every race, gender, sexuality, age, location
and income-deserves the opportunity to live their healthiest life.
Today, however, there are still far too many barriers to good
health which are disproportionately experienced by people of color,
historically marginalized groups and those with lower incomes. We
are committed to mitigating our impact on the environment and
enabling and delivering equitable care that addresses health
disparities and improves health outcomes - an enterprise priority
reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer
under applicable law and qualified applicants will receive
consideration for employment without regard to race, national
origin, religion, age, color, sex, sexual orientation, gender
identity, disability, or protected veteran status, or any other
characteristic protected by local, state, or federal laws, rules,
or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are
required to pass a drug test before beginning employment.
Keywords: UnitedHealth Group, National City , Sr. Network Pricing/Capitation Consultant - Remote, Professions , Cypress, California
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