Practice Performance Manager Medicare Consultant Overland Park, KS

UnitedHealth Group • Overland Park, KS

115d • $71,200 - $127,200 • Remote

About The Position

The 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 suspect closure. The individual 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. This individual will review charts (paper and electronic - EMR), identify gaps in care and open suspect opportunities. Work is primarily performed at physician practices on a daily basis.

Requirements

• 5+ years of healthcare industry experience
• 2+ years of Medicare Advantage including Stars and Risk Adjustment
• 1+ years of provider facing experience
• Intermediate level experience Microsoft Office experience including Excel with exceptional analytical and data representation expertise and PowerPoint
• Willing to travel 75-80% for business meetings (including client/health plan partners and provider meetings) and 20-25% remote work
• Driver's License and access to reliable transportation
• Reside in the state of Kansas

Nice To Haves

• Registered Nurse
• Experience working for a health plan and/or within a provider office
• Experience with network and provider relations/contracting
• Experience retrieving data from EMRs (electronic medical records)
• Experience in management or coding position in a provider primary care practice
• Knowledge base of clinical standards of care, preventive health, and Stars measures
• Knowledge of billing or claims submission and other related actions

Responsibilities

• Functioning independently, travel across assigned territory to meet with providers to discuss UHC and Optum tools and UHC incentive programs for quality reporting, focused on improving the quality of care for Medicare Advantage Members
• 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
• Access PCOR and utilize other available reporting sources including but not limited to (InSite, Spotlight, Doc360, Provider Scorecard, CPT II Report) to analyze data and prioritize gap and suspect closure, identify trends and drive educational opportunities
• Coordinates and provides ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
• Training will include Stars measures (HEDIS/CAHPS/HOS/medication adherence), coding for quality care (CPT II) and exclusions (ICD-10-CM), and Optum program administration including use of plan tools, reports and systems
• Lead regular Stars and risk adjustment specific JOC meetings with provider groups to drive continual process improvement and achieve goals
• Provide reporting to health plan leadership on progress of overall performance, MAPCPi, gap closure, and use of virtual administrative resources
• Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
• Collaborates and communicates with the member's health care and service with our interdisciplinary delivery team to coordinate the care needs for the member
• Partner with providers to engage in UnitedHealthcare member programs such as HouseCalls, clinic days, Navigate4Me

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree