Practice Performance Manager - Medicare Consultant - Kansas - 2283532

UnitedHealth Group; Overland Park (KS); Remote; Confidential; Full time

Job summary

A leading healthcare organization is seeking a Practice Performance Manager - Consultant to implement programs and manage provider performance. The role involves building relationships with care providers, analyzing data for performance improvement, and conducting training. This position offers flexibility to work remotely and requires significant travel. Candidates should have healthcare experience and relevant certifications.

Benefits

Comprehensive Benefits

Incentives

Stock Purchase Options

401k Contributions

Qualifications

• 5+ years of healthcare industry experience.
• 2+ years of Medicare Advantage experience.
• 1+ years of provider-facing experience.

Responsibilities

• Travel across assigned territory to meet with providers.
• Establish consultative relationships with physicians and medical groups.
• Conduct quarterly chart reviews and provide feedback.

Skills

Analytical Skills

Data Visualization

Communication

Education

Certified Risk Adjustment Coder (CRC)

Certified Professional Coder (CPC)

Certified Coding Specialist - Physician (CCS-P)

Tools

Microsoft Excel

Microsoft PowerPoint

Job description

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 diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Practice Performance Manager - Consultant is responsible for program implementation and provider performance management, tracked by designated provider metrics, including at least 4 STAR gap closure and coding accuracy demonstrating full assessment and suspect closure. The individual 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 desired results. This includes reviewing charts (paper and electronic - EMR), identifying care gaps and suspect opportunities, and educating providers to ensure high-specificity coding for risk adjustment and quality reporting. Work is primarily performed at physician practices on a daily basis.

If you are located in Kansas, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

1. Travel across assigned territory to meet with providers, discuss UHC and Optum tools, and UHC incentive programs, focusing on improving care quality for Medicare Advantage Members.
2. Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs, and ACOs.
3. Develop provider-specific plans to improve HEDIS performance, facilitate risk adjustment suspect closure, and enhance outcomes.
4. Utilize PCOR and other reporting sources (InSite, Spotlight, Doc360, Provider Scorecard, CPT II Report) to analyze data, prioritize gap closure, identify trends, and drive education.
5. Conduct quarterly chart reviews and provide feedback to providers to improve reporting.
6. Perform additional chart reviews, such as post-visit ACV reviews, to improve documentation and coding, leading to better gap and suspect closure.
7. Coordinate and provide ongoing strategic recommendations, training, and coaching to provider groups on program implementation and barrier resolution.
8. Train providers on Stars measures (HEDIS/CAHPS/HOS/medication adherence), coding practices (CPT II, ICD-10-CM), and Optum program tools.
9. Lead regular Stars and risk adjustment meetings with provider groups to drive process improvement and meet goals.
10. Report progress to health plan leadership on performance metrics and resource utilization.
11. Facilitate and lead meetings, including report and material preparation.
12. Coordinate care with interdisciplinary teams to meet member needs.
13. Partner with providers to engage in member programs like HouseCalls, clinic days, and Navigate4Me.
14. Willing to travel up to 75-80% for meetings and 20-25% remote work.

You’ll be rewarded and recognized for your performance in an environment that challenges you and provides clear development pathways.

Required Qualifications:

• Certified Risk Adjustment Coder (CRC via AAPC) or Certified Professional Coder (CPC via AAPC) or Certified Coding Specialist - Physician (CCS-P via AHIMA), with a plan to obtain both certifications within the first year if not already certified.
• 5+ years of healthcare industry experience.
• 2+ years of Medicare Advantage experience, including Stars and Risk Adjustment.
• 1+ years of provider-facing experience.
• Intermediate Microsoft Office skills, especially Excel and PowerPoint, with strong analytical and data visualization capabilities.
• Reside in Kansas.

Preferred Qualifications:

• Registered Nurse.
• Experience in health plan operations or provider offices.
• Experience with network/provider relations and contracting.
• Experience retrieving data from EMRs.
• Management or coding experience in primary care practices.
• Knowledge of clinical standards, preventive health, and Stars measures.
• Understanding of billing, claims, and related processes.

*Remote work is subject to UHG’s Telecommuter Policy.

The salary range is $89,800 to $176,700 annually, based on full-time employment, experience, and other factors. Benefits include comprehensive packages, incentives, stock purchase options, and 401k contributions. Benefits are subject to eligibility.

Our mission is to help people live healthier lives and improve the health system for everyone, addressing disparities and promoting health equity. UHG is an Equal Opportunity Employer and a drug-free workplace, requiring drug testing prior to employment.