Manager, Medicare Practice Performance Management - Hartford, CT

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 and help people live healthier lives while doing your life's best work.(sm)
 
The Manager, Medicare Practice Performance 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.
 
This is a field based role with frequent on-site visits and meetings with providers, which includes up to 75% travel.
 
Primary Responsibilities:


Leadership and supervisory responsibility for multiple markets and Practice Performance Team (10 - 12 team members) located within those markets

Lead external relationships with targeted larger physician groups / Tier 1 provider accounts (multiple high volume Star providers with over 2,000 members). Drive Star performance and gap closure

Ensure providers understand incentive opportunities and receive ongoing feedback and report cards designed to motivate and optimize provider incentive payouts. Lead coordination of onsite training focusing on STARs measures. (HEDIS / CAHPS / HOS / med adherence), Optum Programs (HQPAF, Chart Audits)

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

Support larger regional and market team by sharing expertise and serving as a touch point/SME for contracting and account management questions. Act as coach, supervisor and mentor to regional provider consultants

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

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

Required Qualifications:


Bachelor’s Degree required or equivalent work experience

7+ years of healthcare industry experience

5+ years of experience working for a health plan and/or for a provider's office

3+ years of management/supervisory experience (staff management)

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

Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills required

Strong knowledge of the Medicare market
Preferred Assets:


Medical / clinical background

Strong knowledge of electronic medical record systems

Consulting experience highly preferred

Experience in managed care working with network and provider relations / contracting

Strong problem - solving skills

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

Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels

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


Strong communication and presentation skills

Strong relationship building skills with clinical and non-clinical personnelProven ability to build strong relationships with the provider community

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world?s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
 
 
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.
 
 
Job Keywords: Stars, Performance Manager, Quality Advocate, Quality, Project Management, Consulting, Providers, Member Groups, Contracts, Health Plan, Quality Improvement, Field Based, Hartford, CT, Connecticut