Senior Practice Support Specialist
About The Position
WellMed, part of the Optum family of businesses, is seeking a Senior Practice Support Specialist to join our team in Florida. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone. At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. The Sr. Practice Support Specialist (PSS) serves as a clinical liaison between contracted primary care practices and WellMed contracted clinical operations. This role is designed to drive value-based care performance and reduce avoidable utilization through proactive patient outreach, coordinated clinical interventions, and improved provider engagement. The PSS supports practices in managing high-risk patients and implementing population health strategies aligned with organizational priorities. This role reports to the Provider Relations Leader and works in a matrixed leadership environment. Clinical activities will occur under the direction of the WellMed Senior Medical Director and in accordance with Company protocols, established nursing practice standards, and the relevant state regulatory requirements. The role is field based with an expected travel requirement of 75–85% to contracted provider offices.
Requirements
- Associates Degree in Nursing
- Current, unrestricted RN license required, specific to the state of employment or able to obtain compact license within 30 days of hire
- 4+ years in any combination of provider relations, network management, care management, and/or clinical operations.
- Medicare Advantage, HEDIS, STAR, CMS reimbursement models, risk adjustment
- Proven solid analytics, communication, relationship-building, and proficiency in Microsoft Office
- Ability to travel extensively (up to 75–85%) and possess a valid drivers license issued by the state of practice
Nice To Haves
- Bachelor’s degree in Business or Healthcare Administration
- CPC Certification
- Experience in value-based care or population health management
Responsibilities
- Manage patient census across assigned practices, focusing on high-risk and high cost cohorts
- Monitor and influence key utilization metrics: ER visits, Admits/K, Readmits/K, SNF/ASC/hospital usage, and palliative care engagement
- Serve as a liaison between PCPs, hospitalists, specialists, and care management programs to ensure coordinated care delivery
- Support practices in implementing contingency plans for high-risk patients (HF, COPD), including documentation of advanced directives and care bundle elements
- Conduct weekly touchpoints with the medical director dyad partner to review admissions and determine escalations to contracted providers
- In partnership with PBM and Medical Director team, analyze utilization and performance data to identify trends and root causes
- Develop action plans aligned with market goals (quality, cost, coding)
- Produce and share scheduled/ad-hoc reports on key metrics
- Ensure monthly visits for Band 5 and other high-risk cohorts per prioritization list.
- Facilitate timely follow-up for hospital discharges and transitions of care
- Conduct weekly 'tuck-in calls' to high-risk members
- Provide education on call us first
- Assist practices in managing high-cost patients and ensuring follow-up on screenings and lab measures
- Support referral management aligned with preferred specialist strategy
- Facilitate Tier 1 Cardiology/HF clinic referrals and support optimization of guideline directed medical therapy (GDMT)
- Provide education and baseline support for risk adjustment documentation before coder SME engagement
- Drive timely closure of care gaps (medication adherence, preventive screenings, HEDIS/STAR measures)
- Assist practices in understanding and applying QRA strategies
Benefits
- a comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
