Associate Practice Performance Manager

4 weeks ago

Winchester, Kentucky, United States Optum Full time

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Associate Practice Performance Manager is responsible for program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy. The person in this role is expected to work directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results. The person will review charts (paper and electronic - EMR), look for gaps in care, perform telephonic assessments for preventative screenings and/or HEDIS gaps in care, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention. Work is primarily performed at physician practices on a daily basis. This position does not entail any direct member care* nor does any case management occur. (*with the exception of participating in health fairs and/or health screenings where member contact could occur)

This is a field-based position in KY with the ability to cover Kentucky market.

Primary Responsibilities:

  • Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members
  • Execute applicable provider incentive programs for health plan
  • Assist in the review of medical records to highlight Star opportunities for the medical staff
  • Activities include data collection, data entry, quality monitoring, upload of images, and chart collection activities
  • Locate medical screening results/documentation to ensure quality measures are followed in the closure of gaps. Will not conduct any evaluation or interpretation of Clinical data and will be supervised by licensed and/or certified staff
  • Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
  • Develop comprehensive, provider-specific plans to increase their HEDIS performance and improve their outcomes
  • Provide ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
  • Act as lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation. Training will include Stars measures (HEDIS/CAHPS/HOS/med adherence), and Optum program administration, use of plan tools, reports and systems
  • Coordinate and lead Stars-specific JOC meetings with provider groups with regular frequency to drive continual process improvement and achieve goals
  • Provide reporting to health plan leadership on progress of overall performance, gap closure, and use of virtual administrative resource
  • Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
  • Provide suggestions and feedback to Optum and health plan
  • Work collaboratively with health plan market leads to make providers aware of Plan-sponsored initiatives designed to assist and empower members in closing gaps
  • Travel up to 75% within Kentucky market
  • Other duties, as assigned

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:

  • 1+ years of STARs, HEDIS or Value Based Care experience
  • 1+ years of account management or sales experience - field based
  • 2+ years of healthcare industry, health plan or medical office
  • Proven solid communication and presentation skills
  • Proven solid relationship building skills with clinical and non-clinical personnel
  • Microsoft Office specialist with analytical and data representation expertise; Excel, Outlook, and PowerPoint skills
  • Willing and able to travel up to 75% through the state of Kentucky

Preferred Qualifications:

  • Demonstrated medical/clinical background
  • Proven solid knowledge of electronic medical record systems
  • Consulting experience
  • Proven solid knowledge of the Medicare & Medicaid market
  • Demonstrated knowledge base of clinical standards of care, preventive health, and Stars measures
  • Experience in managed care working with network and provider relations/contracting
  • Proven solid problem-solving skills
  • Proven solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)

The salary range for this role is $59,500 to $116,600 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.

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.

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.

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