You might also like
in Fort Myers, FL
Practice Performance Manager - Fort Myers & West Palm, FL - Full-time / Part-time
Hours | Full-time, Part-time |
---|---|
Location | Fort Myers, FL Fort Myers, Florida |
About this job
- 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
- Provide reporting to health plan leadership on progress of overall performance, HQPAFs, gap closure, and use of virtual administrative resource
- 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 50 - 75% local travel
Requirements
- 3+ years of healthcare industry experience
- Strong knowledge of Medicare
- Previous exposure to HEDIS regulations
- 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
- 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
- A minimum of 1 year of Stars experience highly preferred
- Consulting experience
- Project Management experience
- Previous experience in a Sales focused role
- 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
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.
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.