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The Account Manager has geographic responsibility for the quality and economic performance of the physician practice with the goal of developing a high performing provider network within the State of Kansas and Missouri. This includes analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. The Network Performance Manager will develop and sustain a solid day-to-day relationship with stakeholders, the physician and office staff to effectively implement the business solutions developed by the Client Services leadership team. The Network Performance Manager is accountable for overall performance and profitability for their assigned groups as well as ownership and oversight to provide redirection as appropriate and approved. The responsibilities of this position include capabilities in the following areas: strategic planning and analysis; understanding of HEDIS, Star ratings, accurate documentation, and coding; advanced communication skills; and the ability to develop clear action plans and drive process.
Primary Responsibilities:
- Educate providers to ensure they have the tools needed to meet quality, coding and documentation, and total medical cost goals per business development plans
- Develops strategies and create action plans that align provider pools and groups with company initiatives, goals, quality outcomes, program incentives, and patient care best practices
- Drive processes and improvement initiatives that directly impact revenue, HEDIS/STAR measures and quality metrics, coding and documentation process and educational improvements
- Conduct new provider orientations and ongoing education to provider and their staff on healthcare delivery products, health plan partnerships, processes, and tools
- Use and analyze data to identify trends, patterns and opportunities for the business and clients, and collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
- Conduct provider meetings to share and discuss reporting data and analysis, issue resolution needs, implement escalation processes for discrepancies, and manages or ensures appropriate scheduling, agenda, and materials
- Collaborates with internal clinical services teams, alongside operational leaders’ leaders, to monitor utilization trends to assist with developing strategic plans to improve performance
- Assists provider groups with investigating standard and non-standard requests and problems, to include claims and member support services
- Maintains effective support services by collaborating effectively with the medical director, operations, and cross functional teams, and other departments
- Demonstrate understanding of providers' business goals and strategies to facilitate the analysis and resolution of their issues
- Performs all other related duties as assigned
You will be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Years of post-high school education can be substituted/is equivalent to years of experience.
Required Qualifications:
- 4+ years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree
- 3+ years of experience in a related medical field or health plan setting (network management, contracting and/or recruitment, or provider relations)
- Solid working knowledge of Medicare health care operations including HEDIS, CMS reimbursement models, and Medicare Advantage
- Knowledge of state and federal laws relating to Medicare
- Understanding of IPAs, Clinically Integrated Networks, Medicare Shared Savings Programs, capitation/value-based contracting, and narrow networks
- Proficiency in Microsoft Word, Excel, and PowerPoint
- Proven solid business acumen, analytical, critical thinking, and persuasion skills
- Proven solid verbal and written communication skills
- Demonstrated ability to develop long-term positive working relationships
- Demonstrated ability to communicate and facilitate strategic meetings with groups of all sizes
- Demonstrated ability to work independently, use good judgment and decision-making process
- Demonstrated ability to conduct performance evaluation to identify performance measures or indicators and the actions needed to improve or correct performance, relative to the goals
- Demonstrated ability to resolve complete problems and evaluate options to implement solutions
- Demonstrated ability to adopt quickly to change in an ever-changing environment
- Demonstrated ability and willingness to travel, both locally and non-locally, as determined by business need
- Ability to travel 25% of the time
Preferred Qualifications:
- 5+ years of in a healthcare related field
- Demonstrated ability to function as a mentor to others
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
