Provider Performance & Quality Improvement Lead

ISHE; Tigard (OR); Remote; USD 73,000 - 130,000; Full time

Benefits offered by this job

Benefits package

401k contribution

Stock purchase program

Job summary

UnitedHealthcare is seeking a Practice Performance Manager to drive program implementation and provider performance management, with a focus on STARs, HEDIS, and coding accuracy. The role involves building strong provider relationships, education, and actionable reporting across Medicare Advantage programs.

The position requires 5+ years in health care, STARs experience, and strong data analytics with advanced Excel. Travel is expected 60% with 40% remote work, in Oregon and surrounding regions.

Qualifications

• 5+ years of healthcare industry experience.
• 3+ years with a health plan or provider's office.
• 1+ years of STARs experience.
• Proficient in Microsoft Office with advanced Excel, Outlook, and PowerPoint.
• Strong communication and presentation skills.
• Proven relationship-building with clinical and non-clinical staff.
• Must be able to travel 60% and work remotely 40%.

Responsibilities

• 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
• Weekly commitment of 60% travel for business meetings (including client/health plan partners and provider meetings) and 40% remote work

Skills

Advanced Excel

Data analysis

Relationship building

Communication skills

Travel willingness

PowerPoint

EMR knowledge

Tools

EMR systems

Excel

Outlook

PowerPoint

Job description

UnitedHealthcare is seeking a Practice Performance Manager to drive program implementation and provider performance management, with a focus on STARs, HEDIS, and coding accuracy. The role involves building strong provider relationships, education, and actionable reporting across Medicare Advantage programs.

The position requires 5+ years in health care, STARs experience, and strong data analytics with advanced Excel. Travel is expected 60% with 40% remote work, in Oregon and surrounding regions.