Practice Performance Manager - Chattanooga, TN

UnitedHealth Group•Chattanooga, TN

3d•$71,200 - $127,200•Onsite

About The Position

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. This role is responsible for provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy. The person in this role is expected to work directly with care providers to build relationships, ensure effective education and reporting, and to proactively identify performance improvement opportunities through analysis and discussion with subject matter experts. The person will review charts (paper and electronic - EMR), look for gaps in care, perform telephonic assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention. Work is primarily performed at physician practices on a daily basis.

Requirements

3+ years of healthcare industry experience (Provider Office Operations, STARs Quality Improvement, HCC Coding Education, Provider Engagement/Liaison)
1+ years of STARS or RAF experience
Demonstrated knowledge base of clinical standards of care, preventive health, and Stars measures
Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint
Based in the Chattanooga, TN area
Ability to travel locally up to 75% within the Chattanooga area (mileage reimbursement provided)
Driver's License and access to reliable transportation

Nice To Haves

Certified Professional Coder (CPC) and/or Certified Risk Adjustment Coder (CRC)
Experience in managed care working with network and provider relations and engagement
Consulting experience
Knowledge of electronic medical record systems
Knowledge of the Medicare market
Medical/clinical background
Financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
Proven solid communication and presentation skills
Proven solid relationship building skills with clinical and non-clinical personnel
Proven solid problem-solving skills

Responsibilities

Manage assigned practices to performance goals: 4 STAR gap closure and 90% of HCC covered
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
Functioning independently, travel across assigned territory to meet with providers to discuss UHG tools and programs focused on attestation completion, HCC coding and documentation accuracy and improving the quality of care for Medicare Advantage Members
Review HCC performance and conduct chart reviews as needed to share targeted coding and documentation education with providers
Facilitate and prepare for monthly meetings with practices, including report and material preparation
Provide suggestions and feedback to Population Health leadership team
Participate within department campaigns to improve overall quality improvements within measure star ratings or contracts
Work internally with leadership on adhoc projects, initiatives, and sprints to address measure star ratings and increase overall measure performance
Share reports with assigned practice leadership and providers and explain opportunity areas and operational steps for achievement
Work with practices to establish workflows for attestation completion and gap closure
Actively report challenges and barriers to practice performance with Senior PPM and collaborate on solutions
Proactively work on action plans for targeted provider groups to increase healthcare delivery, star ratings, and maximize on gap closures