Director of Client Services - Remote from North or South Carolina

UnitedHealth Group•Raleigh, NC

16h•$112,700 - $193,200•Remote

About The Position

The Director of Client Services has the responsibility for overseeing, developing, maintaining and servicing a high quality, and satisfied contracted provider network. Key accountabilities of this position include the overall Quality and Risk Adjustment performance of the contracted network providers, strategic vision and planning, and the maintenance of a CMS adequate network. Additional duties include ensuring information and data is readily available to market staff and providers to enable them to accurately and effectively document and address member illness burden, improve quality of patient care, appropriate opportunities to reduce costs, and continually improve overall performance. The person in this position will have a solid working knowledge of key drivers of healthcare delivery, financials, total cost of care, and quality management. The Director Client Services helps Providers within their assigned book of business operate successfully within OptumCare’s healthcare delivery model by providing strategic planning and tools to meet goals and builds an equally solid team to effectuate this goal throughout the contracted network. This position is expected to build and sustain solid working relationships with cross functional departments both within the organization and across other organizations including Optum, UHG, and other Care Delivery Organizations. Groups reporting to this position include a team of Account Managers across the states of South Carolina, North Carolina, and Viriginia.

Requirements

Bachelor’s degree in Healthcare or Business Administration or a related field required (8+ years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)
5+ years of provider relations or managed care experience, with an emphasis on network management, operations, financial analysis, and employee supervision
4+ years of management/supervisory experience (ie employee selection, training, coaching, and development as well as process management)
Solid working knowledge of Medicare health care operations including HEDIS, HCC Risk Adjustment, and Medicare Advantage
Proven exceptional interpersonal skills with ability to interface effectively both internally and externally with a wide range of stakeholders, including physicians, office staff, C suite, hospital executives, population health teams, and other health plan staff
Proven excellent analytical and problem-solving skills with effective follow-through
Proven solid verbal and written communication skills
Proven solid knowledge of local provider community

Nice To Haves

Master’s degree with a significant understanding of medical care financing and delivery systems, provider contracting, reimbursement arrangements and network management
Presentation skills for small and large groups
Professional provider relations experience involving physicians and administrative staff
Provider recruitment and contracting experience

Responsibilities

Analyzes data from a variety of statistical and financial reports and develops recommendations, strategic plans and action plans to improve identified deficits, barriers, and root cause issues.
Works closely with key physician groups to develop long-term strategic relationships alongside internal departments or subject matter experts, and others as needed.
Works throughout organization at all levels to build actionable plans and strategies that will further the mission of the organization, drive high-quality execution while also driving efficiencies, and ultimately deliver better healthcare to members.
Ensures Providers have in depth understanding of the Optum Care Model to include, but not limited to, contractual obligations, program incentives, patient care best practices, quality/HEDIS STAR, risk adjustment, growth, and total cost of care in an effort towards business goals and targets.
Develops and maintains positive provider relationships and responsible for interpreting and explaining issues related to contracting and reimbursement.
Assists internal and external customers with difficult servicing issues and researches or resolves highly complex or escalated concerns related to credentialing, claims, eligibility, utilization management, quality, and risk adjustment programs.
Continuously strives to ensure that favorable relationships are maintained while ensuring the interest of the organization.
Drives change and innovation through continually seeking and implementing value added solutions for clients while working cross-functionally with various departments.
Communicate and advocate providers' needs to internal stakeholders in order to drive creation of solutions that meet our mutual business goals.
Collaborates with leadership and network medical director to conduct provider meetings to share and discuss economic data, identify and support best practices and escalates discrepancies for resolution, as needed.
Assists leadership with operational implementations that include but are not limited to, building and growing an effective and high performing region, seamless onboarding of newly contracted provider groups, and developing positive provider relationships.
Understands multiple payer relationships within market and ensures any operational issues are visible to the appropriate parties and ensures issue resolution.
Manages direct reports to ensure they meet performance expectations, and mentor, coach, and counsel as necessary.
Provides guidance in professional development activities and goals.
Works to promote teamwork, collaboration, and implementation of best practices across all departments within the region.
Performs all other related duties as assigned.
Assists in aligning people and projects to achieve initiatives.
Works with direct reports to develop goals and objectives.
Works with direct reports to establish performance standards for work assignments, monitors work status and progress including goals and objectives.
Values cultural diversity and other individual differences in the workforce, ensuring that the organization builds on these differences.
Ensures employees are treated in a fair and equitable manner.
Complies with all EEO obligations and responsibilities.
Develops staff through coaching, mentoring, rewarding, training, and guiding.
Empowers employees and recognizes and rewards their contributions.
Surrounds self with highly capable people.
Assists in managing employee issues and resolving grievances.
Assists in interviewing, hire, and orient direct reports.
Assists in completing performance evaluations for direct reports on a timely basis.
Notifies Manager of possible employee performance or behavior problems may assist in disciplinary or termination process.
Assists all staff in the interpretation of policies and procedures.
Assesses current and future staffing needs based on organizational goals.
Utilizes compensation data provided by Human Resources.