Value-Based Program Specialist

UnitedHealth Group•Lexington, KY

4d•$60,200 - $107,400•Remote

About The Position

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? 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. The role also serves as a consultative partner to providers and practice staff by building solid working relationships, proactively identifying performance improvement opportunities through data analysis and collaboration with subject matter experts, helping implement provider-specific action plans to improve outcomes, and supporting provider performance management tied to designated provider metrics, including quality gap closure and coding accuracy. This is a field-based position based in Lexington, KY.

Requirements

3+ years of healthcare industry experience
1+ years of HEDIS STARs 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
Driver’s License and access to reliable transportation
Reside in the Lexington, KY area

Nice To Haves

1+ years of experience working for a health plan, provider’s office
Experience in managed care working with network and provider
Experience with HCC/RAF risk adjustment models
Experience with HEDIS/STARS quality programs
Experience in a clinic-based healthcare setting
Solid knowledge of electronic medical record systems
Medical/clinical background
Proficiency with Excel and data manipulation

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
Support chart collection, data entry, and medical record retrieval activities needed to validate quality measure completion and close documentation gaps
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 and 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
Provide reporting to leadership on overall performance, care gap closure progress, and key improvement initiatives, and prepare reports and supporting materials for monthly or quarterly performance meetings as needed
Build and maintain solid, 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
Develop provider-specific performance improvement plans, facilitate regular provider performance meetings to drive continuous improvement, and coordinate internal subject matter experts and resources to support provider education, barrier resolution, and workflow optimization