Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)
WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient's health. WellMed's proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.
This position functions as a subject matter expert in network operations. This position strives to bring consistency and experience to the local market by analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. This position will organize and assist in achieving short and long term operational / strategic business goals/ by developing, enhancing and maintaining operational information and models. They also develop, in conjunction with the local Director / Manager, and implement effective / strategic business solutions through research and analysis of data and business processes. General Profile
- Analyzes risk pool and provider group performance to determine areas of focus or improvement opportunities
- Develops strategies to align contracted provider groups with company initiatives, goals (revenue and expense) and quality outcomes
- Create and develop action plans to achieve metrics in quality, coding and financial performance
- Provides explanations and interpretations within area of expertise
- Provides daily direction and guidance and acts as the subject matter expert for their assigned area
- Uses pertinent data and facts to identify and solve a range of problems through experience, research and collaboration
- Assists with investigating non-standard requests and problems
- Prioritizes and organizes assigned workload to meet deadlines while delivering the best outcomes possible
- Provides explanations, direction and information to others on topics within area of expertise
- Collaborates with local Medical Director(s) to monitor utilization trends and profit pools to assist with developing strategic plans to improve performance
- Strong analytical skills required to support, compile and report key information
- Drive processes and technology improvement initiatives that directly impact Revenue, HEDIS/STAR measures and Quality Metrics, using standard project methodology (requirements, design, test, etc.)
- Use data to identify trends, patterns and opportunities for the business and clients
- Develop business strategies in line with company strategic initiatives
- Engage provider staff and providers in analysis and evaluation of functional models and process improvements; identify dependencies and priorities
- Evaluate and drive processes, provider relationships and implementation plans
- Produce, publish and distribute scheduled and ad-hoc client and operational reports relating to the development and performance of products
- Collaborate with other Physician Business Manager- Area Leads to foster teamwork and build consistency throughout the market
- Serves as a liaison to the health plan and all customers
- Requires strong presentation skills, problem solving and ability to manage conflict and identify resolutions quickly
- Have the ability to communicate well with physicians, staff and internal departments
The information listed above is not comprehensive of all duties / responsibilities performed.
This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.
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:
- Bachelor's degree (4+ years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor's degree)
- Knowledge of Managed Care and Medicare programs
- Proficiency in Microsoft Word, Excel and PowerPoint
- Reliable transportation and ability and willingness to travel throughout the area about 75% of the time
Careers with Optum.
- Knowledge of network management, provider contracting and/or recruitment, or provider relations
- Bilingual in Vietnamese
- HEDIS / STAR rating experience
- Risk Adjustment knowledge related to CMS reimbursement models
- Ability to act as a mentor to others
- Ability to resolve complete problems and evaluate options to implement solutions
- Ability to adapt quickly to change in an ever-changing environment
- Ability to develop long-term positive working relationships
- Ability to communicate and facilitate strategic meetings with groups of all sizes
- Strong business acumen, analytical, critical thinking and persuasion skills
- Exceptional interpersonal skills with ability to interface effectively internally with all levels of staff and externally with a wide range of people including physicians, office staff, hospital executives, medical groups, IPA's, the press and community organizations
- Strong verbal and written communication skills
- Knowledge of medical billing, claims or other financial/healthcare
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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Physician Business Management, Physician relations, provider relations advocate, HEDIS, Stars, Risk, HCC coding, Medicare Advantage, Houston, TX, Texas