Associate Practice Performance Manager - Northeast Alabama
About The Position
The Associate Practice Performance Manager is responsible for implementing programs and managing provider performance against designated metrics, including at minimum 4 STAR gap closure and coding accuracy. The role works directly with care providers to build relationships, deliver education and reporting, identify improvement opportunities through analysis and consultation with subject matter experts, and influence provider behavior to achieve performance goals. Work is primarily performed at physician practices. The position does not involve direct member care or case management, though member contact may occur at health fairs or screenings. The manager reviews paper and electronic medical records for care gaps, supports preventive screening and HEDIS gap assessments by phone, helps coordinate doctor appointments, follows up with members after appointments, and assists with wellness and prevention activities. The position requires travel to provider offices throughout Northeast Alabama, with remote work flexibility for people who live within a commutable distance of the area.
Requirements
- At least 3 years of healthcare industry experience.
- At least 1 year of experience working for a health plan and/or provider's office.
- Microsoft Office specialist with exceptional analytical and data representation expertise; advanced Excel, Outlook, and PowerPoint skills.
- Excellent communication and presentation skills.
- Solid relationship-building skills with clinical and non-clinical personnel.
- Ability to travel up to 75% to provider offices throughout Northeast Alabama.
Nice To Haves
- At least 1 year of STARs experience.
- Consulting experience.
- Managed care experience working with network and provider relations or contracting.
- Knowledge of electronic medical record systems.
- Knowledge of the Medicare market.
- Knowledge of clinical standards of care, preventive health, and Stars measures.
- Medical or clinical background.
- Problem-solving skills.
- Financial analytical background within Medicare Advantage plans, including Risk Adjustment and STARS calculation models.
Responsibilities
- Travel independently across the assigned territory to meet with providers about Optum tools and programs intended to improve care quality for Medicare Advantage members.
- Execute applicable provider incentive programs for the health plan.
- Assist in reviewing medical records and highlighting Star opportunities for medical staff.
- Collect and enter data, monitor quality, upload images, and conduct chart collection activities.
- Locate medical screening results and documentation to ensure quality measures are followed in closing care gaps; do not evaluate or interpret clinical data.
- Establish long-term consultative relationships with physicians, medical groups, IPAs, and ACOs.
- Develop provider-specific plans to improve HEDIS performance and 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, plan tools, reports, and systems.
- Coordinate and lead Stars-specific JOC meetings with provider groups to drive process improvement and achieve goals.
- Report progress on overall performance, gap closure, and use of virtual administrative resources to health plan leadership.
- Facilitate or 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.
- Work with health plan market leads to inform providers about plan-sponsored initiatives that assist and empower members in closing gaps.
- Review charts, perform telephonic assessments for preventive screenings and/or HEDIS gaps, help coordinate appointments, and make follow-up calls to members after appointments.
- Perform other duties as assigned.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase.
- 401k contribution, subject to eligibility requirements.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
