Sr. Provider Engagement Specialist - Charlotte, NC

Taleo; Charlotte (NC); Remote; USD 73,000 - 130,000; Full time

Job summary

UnitedHealth Group's OptumCare in Charlotte, NC seeks a Sr. Provider Engagement Specialist to advance provider engagement and drive operational and financial performance for assigned provider groups.

You will analyze provider pools, develop strategies, monitor performance, and collaborate with clinical teams, with up to 70% travel and flexible remote work options for local candidates.

Qualifications

• 5+ years in a related medical field or health plan setting.
• Experience with Medicare operations including HEDIS, CMS models, and Medicare Advantage.
• Experience building long-term relationships and facilitating strategic meetings.
• Willingness to travel up to 70%.

Responsibilities

• Analyze provider pools and performance to identify opportunities for improvement.
• Develop strategies aligning provider pools with company initiatives and quality goals.
• Drive revenue, HEDIS/STAR measures and education improvement initiatives.
• Use data to identify trends and collaborate with colleagues to solve issues.
• Maintain relationships with providers and staff and publish client/operational reports.
• Collaborate with Client Services leaders to ensure market-wide consistency.

Skills

Analytical skills

Data analysis

Stakeholder management

Microsoft Word

Travel readiness

Tools

Microsoft Excel

PowerPoint

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Sr. Provider Engagement Specialist - Charlotte, NC (2386723)

Sr. Provider Engagement Specialist - Charlotte, NC - 2386723

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 to start Caring. Connecting. Growing together.

This position functions as a subject matter expert in Client Service operations. This position strives to bring consistency and experience to existing Provider Engagement Specialists in the local market by analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. This position will organize and assist assigned provider groups and/or financial pools, as well as fellow account managers, in achieving short and long term operational/strategic business goals/ by developing, enhancing and maintaining operational information and models. They also develop and implement, in conjunction with the local Client Services Associate Director and/or Director, effective/strategic business solutions through research and analysis of data and business processes. The Senior Provider Engagement Specialist will develop and sustain a solid day-to-day relationship with stakeholders, the providers, and office staff to effectively implement business solutions developed by the Optum leadership team. The Senior Provider Engagement Specialist is accountable for overall performance and profitability for their 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

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

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%
• Permanent residence within a commutable distance to Charlotte, NC

Preferred Qualifications:

• 3+ years of healthcare management experience
• Experience acting as a mentor to others

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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 to $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 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.

OptumCare 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.

OptumCare is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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