Associate Practice Performance Manager - Field Based - Oklahoma

Full-time

Remote - Oklahoma City, OK

Insurance Carriers and Related Activities

About the position

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 based in the state of Oklahoma.

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
• Other duties, as assigned
• Weekly commitment of 60% travel for business meetings (including client/health plan partners and provider meetings) and 40% remote work

Requirements

• 3+ years of healthcare industry experience
• 1+ year of experience working for a health plan and/or for a provider's office
• Solid communication and presentation skills
• Solid relationship building skills with clinical and non-clinical personnel
• Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills required
• Weekly commitment of 60% travel for business meetings (including client/health plan partners and provider meetings) and 40% remote work
• Reside in the state of Oklahoma

Nice-to-haves

• 1+ year of STARs experience
• Demonstrated medical/clinical background
• Proven solid knowledge of electronic medical record systems
• Consulting experience
• Proven solid knowledge of the Medicare 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)

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution