Clinical Practice Performance Consultant - WA Market

UnitedHealth Group; Seattle (WA); On-site; USD 73,000 - 130,000; Full time

Benefits offered by this job

comprehensive benefits package

incentive and recognition programs

equity stock purchase

401k contribution

Job summary

UnitedHealth Group is seeking a Practice Performance Manager to drive provider performance improvements through analysis, education and collaboration with care providers, focusing on STAR measures and coding accuracy. The role involves program implementation, education, and proactive identification of improvement opportunities.

The position requires travel across the assigned territory to discuss tools and programs, develop provider-specific improvement plans, and coordinate incentives for

Qualifications

• 5+ years of healthcare industry experience.
• 3+ years of experience working for a health plan and/or for a provider's office.
• 1+ years of STARs experience.
• Willing or ability to travel up to 75% locally.
• Proven solid communication and presentation skills.
• Proven solid relationship building skills with clinical and non-clinical personnel.

Responsibilities

• The Practice Performance Manager is responsible for 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.
• 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.
• Lead to pull necessary internal resources together 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.

Skills

Communication skills

Presentation skills

Relationship building

Travel readiness

Tools

EMR systems

Microsoft Excel

Job description

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

This role 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. This position does not entail any direct member care* nor does any case management occur. (*with the exception of participating in health fairs and/or health screenings where member contact could occur)

Primary Responsibilities:

• The Practice Performance Manager is responsible for program implementation and 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, 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

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 5+ years of healthcare industry experience
• 3+ years of experience working for a health plan and/or for a provider's office
• 1+ years of STARs experience
• Willing or ability to travel up to 75% locally
• Proven solid communication and presentation skills
• Proven solid relationship building skills with clinical and non-clinical personnel

Preferred Qualifications:

• Consulting experience
• Experience in managed care working with network and provider relations/contracting
• Medical/clinical background
• Solid knowledge of electronic medical record systems
• Solid knowledge of the Medicare market
• Knowledge base of clinical standards of care, preventive health, and Stars measures
• Proven solid problem-solving skills
• Proven solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
• Microsoft Office specialist with proven exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills required

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as,

• a comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution

(all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.