Provider Relations Representative- Polk County, FL

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)
This position functions as a subject matter expert in network operations. This position strives to bring consistency and experience to existing Physician Business Managers in the local market by analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. This position will sand organize and assist the local Physician Business Managers in achieving short and long term operational/strategic business goals/ by developing, enhancing and maintaining operational information and models. They also develop, in conjunction with the local Director/Manager, and implement effective/strategic business solutions through research and analysis of data and business processes. 
 
Primary Responsibilities:


Analyzes risk pool and provider group performance to determine areas of focus or improvement opportunities

Develops strategies to align contracted provider groups with company initiatives, goals (revenue and expense) and quality outcomes

Creates and develops action plans to achieve metrics in quality, coding and financial performance

Provides explanations and interpretations within area of expertise 

Provides daily direction and guidance to existing local Physician Business Managers and acts as the subject matter expert for their assign area

Uses pertinent data and facts to identify and solve a range of problems through experience, research and collaboration 

Assists local Physician Business Managers with investigating non-standard requests and problems

Prioritizes and organizes assigned workload of local Physician Business Managers is able to meet deadlines while delivering the best outcomes possible

Provides explanations, direction and information to others on topics within area of expertise 

Strong analytical skills required to support, compile and report key information

Drives processes and technology improvement initiatives that directly impact Revenue, HEDIS/STAR measures and Quality Metrics, using standard project methodology (requirements, design, test, etc.) 

Uses data to identify trends, patterns and opportunities for the business and clients

Develops business strategies in line with company strategic initiatives

Engages provider staff and providers in analysis and evaluation of functional models and process improvements; identify dependencies and priorities

Evaluates and drives processes, provider relationships and implementation plans 

Produces, publishes and distributes scheduled and ad-hoc client and operational reports relating to the development and performance of products 

Collaborates with other Physician Business Manager- Area Leads to foster teamwork and build consistency throughout the market 

Serves as a liaison to the health plan and all customers

Required Qualifications:

HS Diploma or GED
3+ years' experience in the medical field or health plan setting 
Working knowledge of managed care and quality of care
Experience presenting group presentations and training  
Intermediate proficiency in Microsoft Word, Excel and PowerPoint
Travel 50% of the time 
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.
United States Citizenship
Preferred Qualifications:

Undergraduate degree 
Risk adjustment experience
Knowledge of Electronic Health Records
Ability to work independently, use good judgment and decision making process 
Ability to conduct performance evaluation to identify performance measures or indicators and the actions needed to improve or correct performance, relative to the goals 
Ability to resolve complete problems and evaluate options to implement solutions 
Ability to adopt quickly to change in an ever-changing environment 
Ability to Develop Long Term Relationships 
Strong Work Ethic & Desire to Succeed 
Ability to sit down with medical groups of all sizes and develop joint action/work plans  
Excellent Oral and Written Communication Skills  
Strong business acumen, analytical, critical thinking, and persuasion skills
 
 
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.
 
Job Keywords:  Senior Physician Business Manager, Business Manager, Healthcare, WellMed, Management, Polk County, FL, Florida, Plant City, Davenport, Lake Wales, Winter Haven, Bartow, Lakeland