Associate Practice Performance Manager - KS Market
About The Position
At UnitedHealthcare, the Associate Practice Performance Manager supports program implementation and provider performance management, tracking designated metrics that include 4 STAR gap closure and coding accuracy. The role works directly with care providers to build relationships, deliver education and reporting, identify performance improvement opportunities through analysis and consultation with subject matter experts, and influence provider behavior to achieve required results. The position reviews paper and electronic medical records for gaps in care, may conduct telephonic assessments for preventive screenings and HEDIS gaps, helps coordinate physician appointments, follows up with members after appointments, and supports member wellness and prevention. Work is primarily performed at physician practices, with local travel across the assigned territory. The role develops provider-specific plans to improve HEDIS performance and outcomes; provides recommendations, training, coaching, and consultation; and coordinates internal resources to support provider education. Training may cover Stars measures (HEDIS, CAHPS, HOS, and medication adherence), program administration, and the use of plan tools, reports, and systems. The position also leads Stars-focused meetings, reports performance progress to health plan leadership, prepares meeting materials, and collaborates with health plan market leads on initiatives to help members close care gaps. The role does not evaluate or interpret clinical data and is supervised by licensed and/or certified staff.
Requirements
- At least 3 years of healthcare industry experience.
- At least 1 year of experience working for a health plan and/or a provider's office.
- Reliable transportation, as the role requires local travel.
- Microsoft Office specialist with demonstrated analytical and data-representation expertise; advanced Excel, Outlook, and PowerPoint skills are required.
- Demonstrated communication and presentation skills.
- Demonstrated relationship-building skills with clinical and non-clinical personnel.
Nice To Haves
- At least 1 year of STARs experience.
- Consulting experience.
- Managed care experience working with network and provider relations or contracting.
- Medical or clinical background.
- Knowledge of electronic medical record systems.
- Knowledge of the Medicare market.
- Knowledge of clinical standards of care, preventive health, and Stars measures.
Responsibilities
- Travel independently across the assigned territory to meet providers and discuss Optum tools and programs focused on improving care quality for Medicare Advantage members.
- Execute applicable provider incentive programs for the health plan.
- Assist with reviewing medical records to identify Star opportunities for medical staff.
- May conduct telephonic member needs assessments according to applicable state and national guidelines, policies, procedures, and protocols.
- May interact with members by telephone to schedule appointments, follow up to assess their understanding of services, answer questions, and confirm completion of procedures related to preventive screenings or HEDIS gaps in care.
- Perform data collection, data entry, quality monitoring, image uploads, and chart collection activities.
- Locate medical screening results and documentation to support closure of quality measure gaps; do not evaluate or interpret clinical data.
- Establish positive, long-term consultative relationships with physicians, medical groups, IPAs, and ACOs.
- Develop provider-specific plans to increase HEDIS performance and improve outcomes.
- Provide ongoing strategic recommendations, training, and coaching to provider groups on program implementation and resolving barriers.
- Coordinate internal resources to deliver provider education, coaching, and consultation, including training on Stars measures, Optum program administration, and plan tools, reports, and systems.
- Coordinate and lead regular Stars-specific JOC meetings with provider groups to drive continuous process improvement and achieve goals.
- Report progress on overall performance, gap closure, and use of virtual administrative resources to health plan leadership.
- Facilitate and lead monthly or quarterly meetings as required by the plan leader, including preparing reports and materials.
- Provide suggestions and feedback to Optum and the health plan.
- Collaborate with health plan market leads to inform providers about plan-sponsored initiatives designed to help members close gaps in care.
- Perform other duties as assigned.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs, subject to eligibility requirements.
- Equity stock purchase, subject to eligibility requirements.
- 401(k) contribution, subject to eligibility requirements.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
