Medicare STARs & Provider Performance Consultant

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

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