This role is responsible for 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, and to proactively identify performance improvement opportunities through analysis and discussion with subject matter experts.
If you are located in Louisville, KY, you will have the flexibility to telecommute* as you take on some tough challenges.
- The 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
- Functioning independently, travel across assigned territory to meet with providers to discuss UHG tools and programs focused on improving the quality of care for Medicare Advantage Members
- Execute applicable provider incentive programs for health plan
- 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
Participate within department campaigns to improve overall quality improvements within measure star ratings or contracts
Work internally with leadership on adhoc projects, initiatives, and sprints to address measure star ratings and increase overall measure performance
Create strategy and action plans for targeted provider groups to increase healthcare delivery, star ratings, and maximize on gap closures
Includes up to 75% local travel
- 5+ years of healthcare industry experience
3+ years of experience working for a health plan and / or for a provider's office
1+ year of STARs experience
Proficient in MS Office applications
Strong communication and presentation skills
Strong relationship building skills with clinical and non-clinical personnel
Ability to travel, locally, up to 75% of the time
- Bachelor’s degree
Medical / clinical background
Strong knowledge of electronic medical record systems
Strong knowledge of the Medicare market
Knowledge base of clinical standards of care, preventive health, and Stars measures
Experience in managed care working with network and provider relations / contracting
Strong problem-solving skills
Strong financial analytical background within Medicare Advantage plans (Risk Adjustment / STARS Calculation models)
Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills
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)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.
Job Keywords: STARS, HEDIS, CMS, Medicare, Quality Measures, Performance Manager, Quality Advocate, Quality, Project Management, Consulting, Providers, Member Groups, Contracts, Health Plan, Quality Improvement, Field Based, Louisville, KY, Kentucky