Provider Relations Advocate - Corpus Christi, TX

UnitedHealth Group • Corpus Christi, TX

6d

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 Physician Business Manager with WellMed is responsible for developing, maintaining, and servicing a high quality, marketable, and satisfied provider network within an assigned geographic area. The Physician Business Manager helps assigned providers operate successfully within our healthcare delivery model by providing strategic planning and tools to meet goals. This position is expected to build and sustain solid working relationships with cross functional departments, vendors, local network, and assigned providers. The Physician Business Manager is accountable for overall performance and profitability for their assigned groups, as well as ownership and oversight to provide redirection as appropriate.

Requirements

• High school diploma or equivalent experience
• 2+ years of provider relations or managed care experience
• Proven exceptional interpersonal skills with ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives, and other health plan staff
• Intermediate level of proficiency with MS Suite (including Word, PowerPoint, and Excel)
• Ability to work evenings and weekends on occasion based on business needs
• Ability to travel as needed 50 - 75%25
• Driver’s License and access to reliable transportation

Nice To Haves

• Bachelor’s degree in related field
• LVN license
• Experience presenting group presentations and training
• Professional provider relations experience involving physicians and administrative staff
• Significant understanding of medical care financing and delivery systems, provider contracting, reimbursement arrangements and network management
• Understanding of medical care financing and delivery systems, provider contracting, reimbursement arrangements, and network management
• Established knowledge of local provider community
• Proven excellent analytical and problem-solving skills with effective follow through

Responsibilities

• Educate providers to ensure that they have the tools they need to meet quality, risk adjustment, growth (as appropriate), and total medical cost goals per business development plans
• Ensure providers have in-depth understanding of WellMed Model of Care to include, but not limited to, contractual obligations, program incentives, and patient care best practices
• Conduct detailed analysis of various reports by tracking and trending data to develop a strategic plan to ensure performance goals are achieved
• Ensure the overall strategic plan incorporates interventions with internal departments or subject matter experts, external vendors, and others, as needed
• Participate in creation and execution of a local network development plan to assure network adequacy as needed
• Conduct new provider orientations and ongoing education to providers and their staffs on healthcare delivery products, health plan partnerships, processes, and compensation arrangements
• Maintain open communication with providers to include solutions for resolution and closure on health plan issues related to credentialing, claims, eligibility, disease management, utilization management, quality, and risk adjustment programs
• Conduct provider meetings to share and discuss economic data, troubleshoot for issue resolution, and implement an escalation process for discrepancies
• Collaborate with provider groups to develop, execute, and monitor performance and patient outcomes improvement plans
• Collaborate with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs
• Handle or ensure appropriate scheduling, agenda, materials, location, meals, and minutes of provider meetings as needed
• Collaborate with contracting team to ensure provider data is correct and provider directories include any needed updates
• Complete Practitioner Data Forms and Provider Change Forms as needed
• Represent WellMed/UHG by holding company sponsored provider events (summits, learning sessions)
• Provide information and participate in management meetings as requested
• Regularly meet with cross functional team to create, revise, and adjust strategy for assigned provider groups to meet overall performance goals
• Provide support to maintain and develop ongoing value related to the WellMed Value Proposition
• Introduce and advocate company resources to facilitate practice optimization
• Ability to travel as needed 50 - 75%25 within market

Benefits

• In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED