Senior Provider Engagement Specialist

UnitedHealth Group; Nashville (TN); On-site; USD 73,000 - 130,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase program

401k contribution

Incentive and recognition programs

Job summary

UnitedHealth Group in Nashville is seeking a Senior Provider Engagement Specialist to serve as a subject matter expert in Client Service operations. You will analyze data, develop strategies, and maintain relationships with provider groups to support revenue and quality outcomes.

The role partners with leadership to implement solutions, monitor utilization trends, and produce reports for stakeholders. Travel up to 70% may be required; strong communication and presentation skills are essential.

Qualifications

• 5+ years of experience in a related medical field or health plan setting.
• Experience with Medicare health care operations including HEDIS, CMS reimbursement models, and Medicare Advantage.
• Experience developing long-term positive working relationships.
• Experience communicating and facilitating strategic meetings with groups of all sizes.
• Experience working independently, using good judgment and decision-making.
• Experience conducting performance evaluations to identify performance measures or indicators and the actions needed to improve or correct performance.
• Knowledge of state and federal laws relating to Medicare.
• Proficiency in Microsoft Word, Excel and PowerPoint.
• Reliable transportation and ability and willingness to travel, up to 70%.

Responsibilities

• Analyze risk pool and provider group performance to determine areas of focus or improvement opportunities.
• Develop strategies and action plans that align provider pools and groups with company initiatives, goals (revenue and expense) and quality outcomes.
• Drive processes and improvement initiatives that directly impact revenue, HEDIS/STAR measures and quality metrics.
• Use and analyze data to identify trends, patterns and opportunities for the business and clients.
• Collaborates with internal clinical services teams to monitor utilization trends and risk pools to assist with developing strategic plans.
• Assists provider groups with investigating standard and non-standard requests and problems, including claims and member support services.
• Maintains effective support services by working with leadership and cross-functional teams.
• Demonstrate understanding of providers' business goals to facilitate issue resolution.
• Performs all other related duties as assigned.

Skills

Communication skills

Presentation skills

Problem solving

Conflict resolution

Travel willingness

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Job description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

The Senior Provider Engagement Specialist serves as a subject matter expert in Client Service operations, bringing consistency, expertise, and operational support to Provider Engagement Specialists within the local market. This position analyzes, reviews, forecasts, trends, and presents information to support operational and business planning.

This role partners with assigned provider groups and/or financial pools, as well as fellow account managers, to achieve short- and long-term operational and strategic business goals by developing, enhancing, and maintaining operational information and models. In partnership with the local Client Services Associate Director and/or Director, the Senior Provider Engagement Specialist develops and implements effective business solutions through research and analysis of data and business processes.

The Senior Provider Engagement Specialist develops and maintains strong day-to-day relationships with key stakeholders, providers, and office staff to effectively implement business solutions developed by the Optum leadership team. This position is also accountable for the overall performance and profitability of assigned provider groups and/or financial pools.

Essential Job Functions

• Analyze risk pool and/or provider group performance to determine areas of focus or improvement opportunities, to include performing analysis of financial statements and other metric-related report to determine areas of focus or improvement opportunities
• Develops strategies and create action plans that align provider pools and groups with company initiatives, goals (revenue and expense) and quality outcomes
• Drive processes and improvement initiatives that directly impact revenue, HEDIS/STAR measures and quality metrics, coding and documentation process and educational improvements
• Use and analyze data to identify trends, patterns and opportunities for the business and clients, and collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
• Collaborates with internal clinical services teams, alongside Client Services leaders, to monitor utilization trends and risk pools to assist with developing strategic plans to improve performance
• Assists provider groups with investigating standard and non-standard requests and problems, to include claims and member support services
• Maintains effective support services by working effectively with the Director of Client Services, Regional Medical Director, Clinical Services team, Operations and other corporate departments
• Demonstrate understanding of providers' business goals and strategies in order to facilitate the analysis and resolution of their issues
• Performs all other related duties as assigned

Primary Responsibilities:

• Data analysis required to support, compile and report key information
• Drive processes and technology improvement initiatives that directly impact Revenue, HEDIS/STAR measures and Quality Metrics, using standard project methodology (requirements, design, test, etc.)
• Use data to identify trends, patterns and opportunities for the business and clients. Develop business strategies in line with company strategic initiatives
• Engage provider staff and providers in analysis and evaluation of functional models and process improvements; identify dependencies and priorities
• Evaluate and drive processes, provider relationships and implementation plans
• Produce, publish and distribute scheduled and ad-hoc client and operational reports relating to the development and performance of products
• Collaborate with other Client Services leads to foster teamwork and build consistency throughout the market
• Serves as a liaison to the health plan and all customers
• Requires solid presentation skills, problem solving and ability to manage conflict and identify resolutions quickly
• Have the ability to communicate well with physicians, staff and internal departments

Required Qualifications:

• 5+ years of experience in a related medical field or health plan setting (network management, contracting and/or recruitment, provider relations or in medical practice)
• Experience with Medicare health care operations including HEDIS, CMS reimbursement models, and Medicare Advantage
• Experience developing long-term positive working relationships
• Experience communicating and facilitating strategic meetings with groups of all sizes
• Experience working independently, using good judgment and decision-making
• Experience conducting performance evaluations to identify performance measures or indicators and the actions needed to improve or correct performance, relative to the goals
• Experience resolving complete problems and evaluating options to implement solutions
• Knowledge of state and federal laws relating to Medicare
• Proficiency in Microsoft Word, Excel and PowerPoint
• Reliable transportation and ability and willingness to travel, both locally in assigned territory and non-locally, as determined by business need up to 70%

Preferred Qualifications:

• Healthcare management experience
• Experience acting as a mentor to others
• Client Management experience

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 and 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. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.