Provider Relations Advocate - Corpus Christi, TX - 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 Provider Relations Advocate/ Network Coordinator is responsible for developing, maintaining and servicing a high quality, marketable and satisfied provider network within an assigned geographic area. Key responsibilities include recruitment, contracting, education and service for physicians and ancillary providers. The Network Coordinator helps assigned primary care physicians operate successfully within the PHC healthcare delivery model. This position works closely with local sales and medical staff as well as corporate network support staff. This position is expected to maintain strong working relationships with assigned physicians, hospitals and ancillary providers.

Primary Responsibilities:

• Under the direction of the Market Manager, works closely with Tier 1 and other PCPs to ensure they have the tools they need to meet Quality Metric goals including DataRaps


• Completes detailed analysis of Quality Metric reports and tracks data at the patient level to ensure new members are seen within 90 days, all members seen annually and completion of the actions needed to meet the remaining quality metrics; provides physician and office education to improve metrics as needed


• Participates in creation and execution of a local network development plan to assure network adequacy


• Recruits and contracts physicians and ancillary providers within established guidelines gather credentialing information and assure provider directory accuracy


• Conducts new provider orientations and deliver in-service training to educate providers and their staffs on PHC products, processes and compensation arrangements


• Maintains open communication with providers on health plan issues related to claims, eligibility, RAPS, disease management, utilization management, reimbursement and quality programs


• Facilitates PCP appointments for new members so PCPs can assess health status, get the member into an appropriate treatment program and refer high risk members to disease management programs


• Collaborates with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs


• Resolves provider and member specific issues related to claims, eligibility and referrals


• Handles scheduling, agenda, materials, location, meals and minutes of provider meetings as needed


• Works closely with contracting team to ensure provider data is correct and Provider directories include any needed updates; completes PIC forms as needed


• Provides information and participate in management meetings as requested


• Performs all other related duties as assigned

Required Qualifications:

• Bachelor's degree in related field (HS Diploma/GED with 4+ additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a Bachelor's degree)


• 3+ years of provider relations or managed care experience


• Exceptional interpersonal skills with ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives and other health plan staff


• Excellent analytical and problem solving skills with effective follow through


• Strong verbal and written communication skills


• Solid knowledge of local provider community

Preferred Qualifications:

• Significant understanding of medical care financing and delivery systems, provider contracting, reimbursement arrangements and network management


• Professional provider relations experience involving physicians and administrative staff


• Provider recruitment and contracting experience

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to 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. Certain positions are subject to random drug testing.

Job Keywords: Provider Relations, Corpus Christi, Texas, TX