Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)
The Quality Practice Performance Manager is responsible for provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy. The person in this role is expected to work directly with care providers to build relationships, ensure effective education and reporting, and to proactively identify performance improvement opportunities through analysis and discussion with subject matter experts.
If you are located in Dallas, Texas, you will have the flexibility to telecommute* as you take on some tough challenges.
Program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy
Work directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results
Functioning independently, travel across assigned territory to meet with providers to discuss UHG tools and programs focused on improving the quality of care for Medicare Advantage Members
Execute applicable provider incentive programs for health plan
Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
Develop comprehensive, provider-specific plans to increase their HEDIS performance and improve their outcomes
Provide ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
Act as lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation. Training will include Stars measures (HEDIS / CAHPS / HOS / med adherence), and Optum program administration, use of plan tools, reports and systems
Coordinate and lead Stars-specific JOC meetings with provider groups with regular frequency to drive continual process improvement and achieve goals
Provide reporting to health plan leadership on progress of overall performance, gap closure, and use of virtual administrative resource
Facilitate / lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
Provide suggestions and feedback to Optum and health plan
Work collaboratively with health plan market leads to make providers aware of Plan-sponsored initiatives designed to assist and empower members in closing gaps
Participate within department campaigns to improve overall quality improvements within measure star ratings or contracts
Work internally with leadership on adhoc projects, initiatives, and sprints to address measure star ratings and increase overall measure performance
Create strategy and action plans for targeted provider groups to increase healthcare delivery, star ratings, and maximize on gap closures
Includes up to 75% local travel
5 years of healthcare industry experience
3 years of experience working for a health plan and / or for a provider's office
Microsoft Office specialist with exceptional analytical and data representation expertise; Proficient Excel, Outlook, and PowerPoint skills
Ability to travel locally up to 75% of the time
Strong communication and presentation skills
Strong relationship building skills with clinical and non-clinical personnel
1 year of STARs / HEDIS experience
Strong knowledge of the Medicare market
Active and unrestricted RN license in current state of residence
Medical / clinical background
Strong knowledge of electronic medical record systems
Knowledge base of clinical standards of care, preventive health, and Stars measures
Experience in managed care working with network and provider relations / contracting
Strong problem-solving skills
Strong financial analytical background within Medicare Advantage plans (Risk Adjustment / STARS Calculation models)
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world?s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: STARs, HEDIS, quality, healthcare, RN, clinical quality, Optum, telecommute, UHG, Dallas, Texas, TX, telecommuter, work from home
Unitedhealth Group Inc.