Practice Performance Manager - Remote in Hawaii

UnitedHealth Group•Honolulu, HI

3d•$72,800 - $130,000•Hybrid

About The Position

The Practice Performance Manager is responsible for program implementation and provider performance management, which is tracked by designated provider metrics, including minimally 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, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results. Positions in this function drive clinical relationships and engagement with physician practices, members, and pharmacies while partnering internally (with areas such as Network contract ACO mgrs, Health Care Economics and Analytics, Medical Directors, Reporting, Health Plan market leaders) with a goal of improving health, well-being, quality and practice performance while reducing medical costs. Positions are accountable for the full range of clinical practice performance which may include but is not limited to improvement on HEDIS and STARs gap closure, coding accuracy, facilitating effective education and reporting, effective super utilizer engagement (e.g., members with complex and/or chronic conditions), and proactively identifying performance improvement opportunities through the use of data analytics, technology, workflow changes and clinical support. These roles develop comprehensive, provider-specific plans to increase their physician practice performance, reduce readmissions and improve their outcomes. Generally work is self-directed and not prescribed. If you are located in Hawaii, you will have the flexibility to work remotely, as well as work in the office as you take on some tough challenges.

Requirements

5+ years of healthcare industry experience
3+ years of experience working for a health plan and/or for a provider's office
1+ year of STARs experience
Proven solid communication and presentation skills
Proven solid relationship building skills with clinical and non-clinical personnel
Weekly commitment of 60%25 travel for business meetings (including client/health plan partners and provider meetings) and 40%25 remote work

Nice To Haves

Consulting experience
Experience in managed care working with network and provider relations/contracting
Solid knowledge of electronic medical record systems
Solid knowledge of the Medicare market
Knowledge base of clinical standards of care, preventive health, and Stars measures
Proven solid problem-solving skills
Proven medical/clinical background
Proven solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills

Responsibilities

Functioning independently, travel across assigned territory to meet with providers to discuss UHG tools and programs focused on improving the quality of care for Medicare Advantage Members
Execute applicable provider incentive programs for health plan
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
Provide ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
Act as lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation. Training will include Stars measures (HEDIS/CAHPS/HOS/med adherence), and Optum program administration, use of plan tools, reports and systems
Coordinate and lead Stars-specific JOC meetings with provider groups with regular frequency to drive continual process improvement and achieve goals
Provide reporting to health plan leadership on progress of overall performance, gap closure, and use of virtual administrative resource
Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
Provide suggestions and feedback to Optum and health plan
Work collaboratively with health plan market leads to make providers aware of Plan-sponsored initiatives designed to assist and empower members in closing gaps
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
Create strategy and action plans for targeted provider groups to increase healthcare delivery, star ratings, and maximize on gap closures