Senior Account Manager

UnitedHealth Group•Wichita, KS

15d•$72,800 - $130,000•Remote

About The Position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Senior Account Manager has geographic responsibility for the quality and economic performance of the physician practice with the goal of developing a high performing provider network within the State of Kansas. This includes analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. The Senior Account Manager will develop and sustain a solid day-to-day relationship with stakeholders, the physician and office staff to effectively implement the business solutions developed by the Client Services leadership team. They are accountable for overall performance and profitability for their assigned groups as well as ownership and oversight to provide redirection as appropriate and approved. The responsibilities of this position include capabilities in the following areas: strategic planning and analysis; understanding of HEDIS, Star ratings, accurate documentation and coding; highly developed communication skills; and the ability to develop clear action plans and drive process.

Requirements

3+ years of experience in a related medical field or health plan setting (network management, contracting and/or recruitment, or provider relations)
2+ years of experience with state and federal laws relating to Medicare
2+ years of experience with Medicare health care operations including HEDIS, CMS reimbursement models, and Medicare Advantage
1+ years of experience with IPAs, Clinically Integrated Networks, Medicare Shared Savings Programs, capitation/value-based contracting, and narrow networks or similar related experience
Advanced level of proficiency in Microsoft Word, Excel and PowerPoint
Ability to travel 25%25 of the time
Access to reliable transportation & valid US driver's license

Nice To Haves

Demonstrated ability to act as a mentor to others
Demonstrated ability to communicate and facilitate strategic meetings with groups of all sizes
Demonstrated ability to work independently, use good judgment and decision-making process
Demonstrated ability to adopt quickly to change in an ever-changing environment
Proven solid business acumen, analytical, critical thinking and persuasion skills

Responsibilities

Educate providers to ensure they have the tools needed to meet quality, coding and documentation, and total medical cost goals per business development plans
Develops strategies and create action plans that align provider pools and groups with company initiatives, goals, quality outcomes, program incentives, and patient care best practices
Drive processes and improvement initiatives that directly impact revenue, HEDIS/STAR measures and quality metrics, coding and documentation process and educational improvements
Conduct new provider orientations and ongoing education to provider and their staff on healthcare delivery products, health plan partnerships, processes, and tools
Use and analyze data to identify trends, patterns and opportunities for the business and clients, and collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
Conduct provider meetings to share and discuss reporting data and analysis, issue resolution needs, implement escalation processes for discrepancies, and handles or ensures appropriate scheduling, agenda, and materials
Collaborates with internal clinical services teams, alongside operational leaders, to monitor utilization trends to assist with developing strategic plans to improve performance
Assists provider groups with investigating standard and non-standard requests and problems, to include claims and member support services
Maintains effective support services by working effectively with the medical director, operations, and cross functional teams, and other departments
Demonstrate understanding of providers' business goals and strategies in order to facilitate the analysis and resolution of their issues
Performs all other related duties as assigned
Solid analytical skills required to support, compile and report key information
Drive processes that directly impact Revenue, HEDIS/STAR measures and Quality Metrics, and total cost of care, as appropriate
Use data to identify trends, patterns and opportunities for the business and clients. Develop business strategies in line with company strategic initiatives
Engage provider staff and providers in analysis and evaluation of functional models and process improvements; identify dependencies and priorities
Evaluate and drive processes, provider relationships and implementation plans
Produce, publish and distribute scheduled and ad-hoc client and operational reports relating to the performance of related metrics and goals
Collaborate with internal leaders to foster teamwork and build consistency throughout the market
Serves as a liaison to the health plan and all customers
Requires solid presentation skills, problem solving and ability to manage conflict and identify resolutions quickly
Have the ability to communicate well with physicians, staff and internal departments