Practice Performance Manager - Houston, Texas - Full-time / Part-time

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)

The Physician Practice Consultant role is responsible for provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy. The person in this role is expected to work directly with care providers to build relationships, ensure effective education and reporting, and to proactively identify performance improvement opportunities through analysis and discussion with subject matter experts.

The role is dedicated to M&R business with dotted line to RVP and responsible for reporting practice performance results to M&R leadership. The position is 'field-based' due to frequent on-site visits and meetings with providers. This means the individual will work out of the home within the designated territory.

Primary Responsibilities:

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  Evaluate current performance of each assigned practice; establish goals unique to each practice with a focus on STARs and gap closure; ensure all applicable groups are performing at 4 stars or higher


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  Evaluate practice office operations with a focus on identifying barriers to achieving targeted outcomes


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  Evaluate and provide feedback to improve performance of provider support personnel, inclusive of clinical and non-clinical personnel


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  Responsible for developing solution-based user friendly initiatives to support practice success


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  Act as lead to pull together necessary internal  resources  to provide appropriate level of provider education and consultation (UHN, Advocates, Physician service, Clinical & Optum, M&R local leadership)


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  Coordinate and lead JOC meetings with provider groups with regular frequency to drive continual process improvement to achieve above mentioned targeted goals


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  Coordinate onsite training focusing on STARs measures (HEDIS, CAHPS, HOS, Med Adherence), Optum Programs (HQPAF, Chart Audits)


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  Ensure providers understands incentive opportunities and receive ongoing feedback and report cards designed to motivate and optimize provider incentive payouts


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  Ensure providers are aware of Plan sponsored initiatives designed to assist and empower members in closing gaps (Member Rewards, Hi Health Innovation, vision, fitness, Renew, Housecalls)


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  Identify opportunities for provider and Plan to join forces in achieving targets, such as sponsorship of wellness day, co-branding, etc.


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  Ensure all claims based issues are triaged to the appropriate party for claims analysis and resolution; ensure timely resolution of all issues brought forth


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  Coordinate Capitated / ACP provider performance results with internal ACP team

Required Qualifications:

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  4+ years of experience working with providers (Provider relations, Provider Network, Pharmacy Representative)


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  3+ years of experience with Medicare and Medicaid; knowledge of the Medicare market, products and competitors


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  Knowledge base of clinical standards of care, preventive health, and STARs measures


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  Strong proficiency with MS Word, Excel, PowerPoint

Preferred Qualifications:

• 4+ years of experience with physician practice analytics and quality improvement management


• Medical/clinical background


• Strong financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models


• Professional experience persuading changes in behavior


• Strong Relationship building skills with clinical and non-clinical personnel


• Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels; proven ability to build strong relationships with the provider community


• Ability to solve process problems crossing multiple functional areas and business units; ability to analyze problems, draw relevant conclusions, and devise and implement an appropriate plan of action


• Working knowledge of available resources and tools (e.g., MML, CMS Competitive Database, KMI Database, others)


• Proficiency in claims processing issue resolution


• Exceptional presentation, written and verbal communication skills


• Ability to work independently and remain on task


• Good organization and planning skills


• Undergraduate or higher level degree

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

Diversity creates a healthier atmosphere: 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.

Job Keywords: STARS, Medicare, Provider Relations, El Paso, Dallas, Houston, Texas, TX