Practice Performance Manager - Fort Myers Territory - Full-time / Part-time

Talk about meaningful work.  Talk about an important role.  Let's talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Practice Performance Manager, you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements. You’ll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives. Here’s your opportunity to discover your life's best work.(sm)
 
The Practice Performance Manager is responsible for program implementation and 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, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results.
 
This is a telecommuting and field-based traveling approximately 75% of the time in the Fort Myers territory which includes the counties of Collier, Lee, Charlotte counties.  
 
Primary Responsibilities:

Function independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members
Execute applicable provider group programs for health plan
Educate providers on how to improve their Risk Adjustment Factor (RAF) scores, which measure their patients' health status
Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and hospitals
Develop comprehensive, provider-specific plans to increase their RAF performance and improve their coding specificity
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
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
Includes up to 75% local travel

Required Qualifications:


3+ years of experience working for a health plan and/or provider offices
Strong knowledge of Medicare
Previous exposure to HEDIS & STAR measures
Previous experience working with Primary Care Physicians
Preferred Qualifications:

Bachelor’s degree or equivalent experience
Medical/clinical background – LPN, RN, or PA licensure helpful
Knowledge base of clinical standards of care, preventive health, and Stars measures
Consulting experience
Project Management experience
Previous experience in a Sales focused role
Previous experience traveling to Provider offices in the field
Strong financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
Exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills
Experience in managed care working with network and provider relations/contracting
Must have highly effective communication and presentation skills
Superior relationship building skills with clinical and non-clinical personnel
Strong problem-solving skills
Advanced Microsoft Office skills
OptumInsight is one of the largest and fastest growing health information companies. We specialize in improving the performance of the health system by providing analytics, technology and consulting services that enable better decisions and results. We integrate workflow solutions that deliver data in real-time, and create actionable insights - processing health information that relates directly to and affects one in four patients in the U.S, one in every three Medicaid dollars and one in every five emergency room visits. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
 
What can YOU do with the right information? At OptumInsight, the possibilities and the impact are limitless. No matter what your role is at OptumInsight, you'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever. It's always fresh. It's always exciting. And it's never been more important.
 
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.
 
 
Keywords: Stars, HEDIS, Performance Manager, Quality Advocate, Quality, Project Management, Consulting, Providers, Member Groups, Contracts, Health Plan, Quality Improvement, Field Based, Fort Myers, Bonita Springs, Cape Coral, Punta Gorda, Collier, Lee, Charlotte FL, Florida.
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