Practice Performance Manager

UnitedHealth Group
Baltimore, MD
Jun 13, 2017
Jun 21, 2017
Full Time
Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Clinical Quality Consultant, you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives. Here's your opportunity to discover your life's best work. (sm) 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.This is a field-based role with a home-based (telecommute, work at home) office. You will be spending approximately 75% of the time in the field within an assigned coverage area. Candidates must be willing to travel within the Baltimore, MD area.Primary Responsibilities: Function 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 group programs for health plan Educate providers on how to improve their Risk Adjustment Factor (RAF) scores, which measure their patients' health status Establish positive, long - term, consultative relationships with physicians, medical groups, IPAs and hospitals Develop comprehensive, provider - specific plans to increase their RAF performance and improve their coding specificity 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, HQPAFs, 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 Includes up to 75% travel within a 2 hour radiusRequired Qualifications:Bachelor's Degree 3+ years of healthcare industry experience Previous experience with STARS and HEDIS regulations and strong knowledge of Medicare Strong financial analytical background within Medicare Advantage plans (Risk Adjustment / STARS Calculation models) Knowledge base of clinical standards of care, preventive health, and Stars measures Advanced MS Office Skills - specifically Excel - must have exceptional analytical and data representation expertise. Advanced Outlook, and PowerPoint skills Must have highly effective communication and presentation skills Superior relationship building skills with clinical and non-clinical personnel Preferred Qualifications:Medical / clinical background - LPN, RN, or PA licensure Consulting experience or Project Management experience Previous experience in a Sales focused role Experience in managed care working with network and provider relations / contracting Strong problem - solving 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)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, Performance Manager, Quality Advocate, Quality, Project Management, Consulting, Providers, Member Groups, Contracts, Health Plan, Quality Improvement, Field Based, Virtual, Telecommute, Baltimore, MD, Maryland

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