Regional Manager, Physician Business Manager - Ft. Myers, FL - 30% Travel - Full-time / Part-time
| Hours | Full-time, Part-time |
|---|---|
| Location | Ft. Myers, FL Ft. Myers, Florida |
About this job
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 purpose of this position is to support contracted physician management objectives through participation in design, development and tactical implementation of strategic business objectives for successful retention, management and growth of the WellMed contracted primary care, specialty care and ancillary provider network. These initiatives should result in the contracted network being able to understand and support the vision to change the face of healthcare delivery for seniors. This will drive the financial viability of the market and provide a full continuum of care for the members.
The responsibilities of this position demand a wide range of capabilities including: strategic planning and analysis skills; strong understanding of billing and collections for physicians and or medical practices; accounting knowledge and understanding of financial statements; understanding of managed care contracts; understanding of HEDIS and HCC coding; management breadth to direct and motivate; highly developed communication skills; political savvy; and the ability to develop clear action plans and drive process, given often ambiguous issues with numerous interdependencies.
This position will act as the liaison between WellMed Medical Management, Inc. and the contracted physicians through close relationships with all key areas of the corporate team including, but not limited to the following: Network Management, Contracting, Finance, Credentialing, Claims, Sales & Marketing, IT, Medical Management, Quality, DataRAPS and Customer Service. This does not preclude the physician groups from directly contacting the various departments as is standard process supported by the Provider Manual. This position will facilitate any unresolved issues that remain as a result from following the standard process.
Primary Responsibilities:
- Manages Physician Business Managers' staff and is responsible for the overall success of the market's network of contracted physicians
Responsible for all aspects of staff development to include hiring, training, coaching and development. Maximizes staff performance and technical expertise through clearly defined objectives, training, skill development and leadership to ensure quality services to all customers
Delegate, monitor, and control work progress on key metrics, initiatives/action plans, staff productivity, and administrative expenses
Maintains and assists with corporate network provider policies, procedures and forms
Participates in development and implementation of systems that support network operations and network management
Maintains effective network support services by working effectively with the Medical Director, Market Medical Director, Regional Team, Clinic Operations and other corporate departments
Handles complex and/or difficult provider inquires and/or problems and facilitates resolution of provider issues
Continuously striving to ensure that favorable relationships are maintained while ensuring the interest of the organization
Takes ownership of total work process and provides constructive information to ensure physician partners have support to meet initiatives
Analyzes data while collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
Demonstrate understanding of providers' business goals and strategies in order to facilitate the analysis and resolution of their issues
Work with relevant internal stakeholders to identify obstacles and barriers identified by providers, and methods for removing them
Communicate and advocate providers' needs to internal stakeholders in order to drive creation of solutions that meet our mutual business goals
Develop resources and programs to assist and educate providers (e.g., web-based training; FAQ document)
Work with internal groups to identify, understand, and/or improve internal tools, resources, systems, and capabilities that can maximize provider, member, or company performance
Assess provider understanding and needs related to industry and company information, tools, systems, and changes
Communicate industry and company information to providers through various means (e.g., newsletters; emails; outreach calls; teleconference; conferences; on-site meetings)
Facilitates and oversees strategic business meetings with physician groups and their staff
Assists with and manages business projections, forecasting and budgets, both financially and with timelines, for assigned projects
Guides, oversees and ensures competency of the Physician Business Manager staff
Produces education tools and monitors Physician Business Manager staff to ensure all education objectives are being met, both on a formal and ad-hoc basis
Responsible for ensuring the Physician Business Manager staff is responding to provider inquiries and resolving provider issues on a daily basis. Facilitates provider discussions and assists in negotiating resolution to escalated provider issues with the capability to determine if/when issues require escalation
Collectively works with Care Management leadership to create, maintain, implement and evaluate business strategic plans that positively impact total medical costs
Trains Physician Business Managers to conduct research on claims, contracts, eligibility, authorization, and negotiates processes and procedures according to contractual language in order to assist providers
Works closely with Corporate Sales & Marketing to attain Membership goals by identifying business opportunities, and retention of key physicians along with internal growth of their practices
Works closely with Quality Practice Support Unit, DataRAPS and Quality departments to attain metric goals by collaboratively creating, maintaining, implementing and evaluating business strategic plans for each area
Develops a complete understanding of entire end to end process of credentialing, contract execution and IKA implementation for the FL market
Understands payer relationships within FL market and ensures any operational issues are visible to the appropriate parties and ensures issue resolution
Continually seeks ways to improve job efficiencies
Performs all other related duties as assigned
Requirements
Required Qualifications:
- Bachelor's degree in Business Administration, Marketing, Healthcare Administration or a related field (or HS Diplomas/GED with 5 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor's degree)
- Five or more years of related experience in network development
- Five or more years of Healthcare Administration at a Health Plan
- Strong working knowledge of Medicare health care operations
- Knowledge of state and federal laws relating to Medicare
- Recently demonstrated successful relationship management experience
Ability and willingness to travel, both locally and non-locally, as determined by business need
This position requires AHCA level II background checks (fingerprinting) by the state of FL for all clinicians that have face to face contact with members or employees who have access to confidential patient data and will require renewal every five years
Preferred Qualifications:
- Master's degree in Business Administration, Marketing, Healthcare Administration
- Five or more years of in a healthcare related field
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)
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Regional Manager, Physician Business Manager, Ft. Myers, FL, Florida