Field Sr. Practice Support Specialist - Corpus Christi, TX

UnitedHealth Group•Corpus Christi, TX

20h•Onsite

About The Position

Explore opportunities with WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will be part of a team who shares your passion for helping people achieve improved health outcomes. Explore rewarding opportunities for physicians, clinical staff and non-patient-facing roles. Join us and discover the meaning behind Caring. Connecting. Growing together. The Sr. Practice Support Specialist (PSS) serves as a clinical liaison between contracted primary care practices and WellMed contracted clinical operations. This role is designed to drive value-based care performance and reduce avoidable utilization through proactive patient outreach, coordinated clinical interventions, and improved provider engagement. The PSS supports practices in managing high-risk patients and implementing population health strategies aligned with organizational priorities. This role reports to the Provider Relations Leader and works in a matrixed leadership environment. Clinical activities will occur under the direction of the WellMed Senior Medical Director and in accordance with Company protocols, established nursing practice standards, and the relevant state regulatory requirements. The role is field-based with an expected travel requirement of 75–85%25 to contracted provider offices.

Requirements

Associates Degree in Nursing
Current, unrestricted RN license, specific to the state of employment or able to obtain compact license within 30 days of hire
4+ years of experience in any combination of provider relations, network management, Medicare Advantage, HEDIS, STAR, CMS reimbursement models, risk adjustment
Solid analytics, communication, relationship-building, and proficiency in Microsoft Office
Ability to travel extensively (up to 75–85%25) and possess a valid drivers license issued by the state of practice

Nice To Haves

Bachelor’s degree in Business or Healthcare Administration
CPC Certification
Experience in value-based care or population health management, care management, and/or clinical operations

Responsibilities

Manage patient census across assigned practices, focusing on high-risk and high-cost cohorts
Monitor and influence key utilization metrics: ER visits, Admits/K, Readmits/K, SNF/ASC/hospital usage, and palliative care engagement
Serve as a liaison between PCPs, hospitalists, specialists, and care management programs to ensure coordinated care delivery
Support practices in implementing contingency plans for high-risk patients (HF, COPD), including documentation of advanced directives and care bundle elements
Conduct weekly touchpoints with the medical director dyad partner to review admissions and determine escalations to contracted providers
In partnership with PBM and Medical Director team, analyze utilization and performance data to identify trends and root causes
Develop action plans aligned with market goals (quality, cost, coding)
Produce and share scheduled/ad-hoc reports on key metrics
Ensure monthly visits for Band 5 and other high-risk cohorts per prioritization list
Facilitate timely follow-up for hospital discharges and transitions of care
Conduct weekly 'tuck-in calls' to high-risk members
Provide education on 'call us first'
Assist practices in managing high-cost patients and ensuring follow-up on screenings and lab measures
Support referral management aligned with preferred specialist strategy.
Facilitate Tier 1 Cardiology/HF clinic referrals and support optimization of guideline-directed medical therapy (GDMT)
Provide education and baseline support for risk adjustment documentation before coder SME engagement
Drive timely closure of care gaps (medication adherence, preventive screenings, HEDIS/STAR measures)
Assist practices in understanding and applying QRA strategies