Job description

Requirements

  • Entry level
  • No Education
  • Salary to negotiate
  • Naperville

Description

Position Description

This role is responsible for provider performance management, which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy. The person in this role is expected to work directly with care providers to build relationships, ensure effective education and reporting, and to proactively identify performance improvement opportunities through analysis and discussion with subject matter experts.
 
If you are located in Illinois, within DuPage, Kane, or DeKalb county or the surrounding area, you will have the flexibility to telecommute* as you take on some tough challenges.
 
Primary Responsibilities:
Program implementation and provider performance management, which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy
Work directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts, and influence provider behavior to achieve needed results
Functioning independently, travel across assigned territory to meet with providers to discuss UHG tools and programs focused on improving the quality of care for Medicare Advantage Members
Execute applicable provider incentive programs for health plan
Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs, and ACOs
Develop comprehensive, provider-specific plans to increase their HEDIS performance and improve their outcomes
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 and 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 75% local travel

Required Qualifications:
Bachelor's degree or equivalent work experience
1+ years of STARs experience
5+ years of healthcare industry experience
3+ years of experience working for a health plan and/or for a provider's office
Preferred Qualifications:
Strong communication and presentation skills
Strong relationship building skills with clinical and non-clinical personnel
Medical / clinical background
Strong knowledge of electronic medical record systems
Consulting experience
Strong knowledge of the Medicare market
Knowledge base of clinical standards of care, preventive health, and STARs measures
Experience in managed care working with network and provider relations / contracting
Strong problem-solving skills
Strong financial analytical background within Medicare Advantage plans (Risk Adjustment/STARs Calculation models)
Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
  
*All Telecommuters will be required to

About the company

Our mission is to help people live healthier lives and to help make the health system work better for everyone.

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 85 million people worldwide.

Our biggest point of differentiation is our people - and the collective talent, energy, intelligence and drive our force of 188,000 individuals around the world bring to our mission every single day. So, how do we do it? With our every action, interaction and intention that demonstrates the five fundamental values that guide everything we do:

• Integrity
• Compassion
• Relationships
• Innovation
• Performance

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