Value-based Program Specialist

UnitedHealth Group•Lexington, KY

6d•Onsite

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 Value-Based Program Specialist is responsible for driving value-based care performance across assigned provider practices by supporting practices with the closure of care gaps, delivering program gap notifications, performing patient outreach, and producing actionable performance reports. This role blends data analysis with frontline provider engagement—educating, coaching, and operationalizing workflows that improve quality, documentation accuracy, patient outcomes, and financial performance under CMS and commercial value-based contracts. This is a field-based position based in Lexington, KY.

Requirements

2+ years of value-based care experience
Proven knowledge of value-based payment models
Proven solid communication and provider engagement skills
Ability to travel up to 60% in the Eastern KY market
Reside in the Lexington, KY market

Nice To Haves

Experience with HCC/RAF risk adjustment models
Experience with HEDIS/STARS quality programs
Experience in a clinic-based healthcare setting
Proficiency with Excel and data manipulation
Proven background in clinical performance improvement, care management, or provider relations

Responsibilities

Identify, prioritize, and drive closure of quality care gaps (e.g., AWV, preventive screenings, chronic condition monitoring) through EMR review, data reconciliation, pre visit planning, and coordinated workflows with practice staff and providers.
Deliver timely, actionable gap-in-care and documentation notifications to providers and practice leadership; track acknowledgement, follow-up action, and resolution through established tasking and report mechanisms.
Manage end-to-end workflows supporting value-based care programs (documentation review, chart retrieval, data exchange, and submission) to ensure accurate coding, compliance documentation and program success.
Conduct targeted outbound patient outreach to support targeted appointment scheduling, care access, and gap closure; identify and escalate barriers to the care team and coordinate services as needed.
Create, maintain, and distribute accurate clinical performance reports (quality, risk adjustment, utilization, and cost trends) using tools such as Excel, Power BI, Tableau, or payor platforms; tailor insights for provider, practice, and leadership audiences.
Analyze CMS, HEDIS, STAR, and payer data to identify trends, root causes, and improvement opportunities; translate analytics into clear, actionable recommendations and support execution and follow-through.
Build and maintain strong, consultative relationships with providers, practice leaders, and internal partners to sustain performance.
Educate and coach physicians, coders, and practice staff on CMS quality programs, HCC/RAF methodology, documentation specificity, coding best practices, and efficient workflows; provide targeted feedback and measurable follow up.