Ewings Associates, Inc. Tricare Network Development Manager in Helena, Montana
Reference # :15-00383Title :Tricare Network Development ManagerLocation :Helena, MTPosition Type :ContractExperience Level :1 YearsStart Date / End Date :03/01/2016 / 03/01/2017 Description
Healthcare Network Development ManagerCurrently looking for a Network Development Consultant in your area to fill an opening on our Tricare Healthcare Network Development team that will service our client UnitedHealthcare Military & Veterans (UHC M&V).Incredible seven-day interviewing process from the point at which you have been submitted to the client by EWINGS. Interested candidates should have a minimum of 3 years of experience in healthcare insurance, managed care, healthcare network development, network contracting, network account management, network negotiating, network maintenance, provider network services, provider network contracting, and network fee schedule development.The scale of this high profile initiative is unprecedented as the newly consolidated Tricare East region will require UHC M&V to build one of the largest healthcare networks ever.Prove your capabilities while on assignment and increase your chances of becoming a UHC M&V full-time employee. (if that is your preference)When applying to EWINGS, please provide you expectations for hourly compensation as an independent contractor without benefits.This opportunity will only come through to fruition if UHC M&V is successful in their bid for the Tricare East region. The award announcement will be made by the Department of Defense at the end of May, early June. The estimated start date is June 6, 2016. The project is estimated to last 12 months or longer.Depending on your proximity to a UHC office, and the availability of UHC workstations, you may either be asked to work in that UHC office for the complete duration of your assignment, or you may be asked to work in that UHC office location during training (3 weeks) and then telecommute from home thereafter.This position will NOT require any travel for face-to-face meetings with providers. Candidates may reside anywhere in the United States even though this will be an East region network build. There will be no reimbursement for travel or related expenses as a result of individuals needing to commute great distances for work or training. Responsibilities of a Tricare Healthcare Network Development Manager for UnitedHealthcare Military & Veterans (UHC M&V).
Develop a Tricare provider network comprised of physicians, hospitals, pharmacies, and ancillary groups that is competitive and provides broad healthcare access to patients.
Negotiate and build a stable Tricare provider network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable healthcare insurance product.
Evaluate and negotiate Tricare contracts with healthcare providers in compliance with contract templates, reimbursement structure standards, and other key process controls.
Establish and maintain relationships with healthcare providers, and ensure the Tricare network composition includes an appropriate distribution of provider specialties.
Provide explanations and interpretations for the provider network roster within your area of expertise.
Requirements of a Tricare Healthcare Network Development Manager for UnitedHealthcare Military & Veterans (UHC M&V).
Undergraduate degree or managed care experience equivalent
3+ years of experience in a healthcare network development, network contracting, account management, provider services, provider contracting, etc.
In-depth knowledge of Medicare reimbursement methodologies, i.e. Resource Based Relative Value System (RBRVS).
2+ years of experience in network fee schedule development using actuarial models.
2+ years of experience utilizing financial models and analysis in negotiating network rates.
Intermediate level of knowledge of claims processing systems and guidelines.
2+ years of experience in performing network adequacy and network gap analysis.
Other previous experiences might include but are not limited to the following
- PPO, HOM, POS, TPA, IPA, CMS, ACO, CPT, RVU. APPD, APC, DRG, Contract Language, Legal Issues, Operations, Medicaid, Emptoris, Claims, Health Plan, Market Analysis, Compliance, Recruiting, etc.