29 days old

Sr. Practice Performance Manager - Boise, ID - 917116

Boise, ID 83702
  • Job Code
    917116

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

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Positions in this function drive clinical relationships and engagement with physician practices, members, and pharmacies while partnering internally (with areas such as Network contract ACO mgrs, Health Care Economics and Analytics, Medical Directors, Reporting, Health Plan market leaders) with a goal of improving health, well-being, quality and practice performance while reducing medical costs. Positions are accountable for the full range of clinical practice performance which may include but is not limited to improvement on HEDIS and STARs gap closure, coding accuracy, facilitating effective education and reporting, effective super utilizer engagement (e.g., members with complex and/or chronic conditions), and proactively identifying performance improvement opportunities through the use of data analytics, technology, workflow changes and clinical support. These roles develop comprehensive, provider-specific plans to increase their physician practice performance, reduce readmissions and improve their outcomes.
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Primary Responsibilities:

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  • Primary relationship owner with provider groups related to UHC incentive programs
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  • Ensure that all applicable UM&R provider groups are performing at 4 stars or higher
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  • Execute applicable provider group programs, e.g. MAPCPi and MCAIP agreements. Execution includes the timely production and delivery of reports with explanation and set up of monitoring and facilitating groups utilization of virtual administrative scheduling and support
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  • Determine appropriate reporting to best serve the provider group. Monitor use of all reports. Compare groups progress with peer groups and best practices. Ensure that reports are accessed and used, as applicable to strategy within the group. Scope and recommend any new reporting needs to impact results
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  • Analyze and evaluate provider group structure and characteristics, provider group/ provider office operations and personnel to identify the most effective approaches and strategies. Identify and assess decision makers and other key provider group personal with a focus on identifying barriers to achieving targeted outcomes. Focus communication and efforts accordingly. Develop solution-based, user friendly initiatives to support practice success
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  • Provide ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution, e.g. targeting members, identifying open gaps prior to visits, scheduling appointments, and closing multiple gaps with proper documentation and coding
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  • Act as lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation for applicable Medicare Advantage programs
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  • Coordinate and lead Stars-specific JOC meetings with provider groups with regular frequency to drive continual process improvement and achieve goals. Actively monitor the performance of the provider groups on ACV, gaps in care, RX measures, and other metrics. Suggest strategies and modify market business plan based upon performance, with ongoing provider group follow-up. Problem-solve and remove barriers to success
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  • Provide reporting to M&R leadership on progress of overall performance, gap closure, and use of virtual administrative resource. Provide real-time escalation of any operational or other issues and concerns to RVP and UHN
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  • Facilitate/lead monthly or quarterly meetings, as required by plan RVP, including report and material preparation
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  • Provide suggestions and feedback to Optum and M&R. Inform and update UHN provider advocates, Medicare
    ""Consultants (RAF) and others on provider groups STAR progress
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  • Work collaboratively with UHN and RVP to make providers aware of Plan-sponsored initiatives designed to assist and empower members in closing gaps
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  • Reviews the work of others
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  • Develops innovative approaches
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  • Sought out as expert
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  • Serves as a leader/ mentor
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Youll 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.

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Required Qualifications:

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  • 5+ years business experience with healthcare industry
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  • 3+ years working with STARS
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  • Understanding of STARS methodologies
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  • Basic knowledge of clinical standards of care and preventive health
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  • Experience in managed care working with network and provider relations/contracting
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  • Strong knowledge of the Medicare market, products and competitors
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  • MS Office proficiency in Outlook, Excel, and PowerPoint
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  • Exceptional analytical and data representation expertise
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  • Ability to solve process problems crossing multiple functional areas and business units
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  • Solid relationship building skills with clinical and non-clinical personnel
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  • Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
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  • Solid communication and presentation skills, as well as professional experience persuading changes in behavior
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  • Solid problem-solving skills; ability to analyze problems, draw relevant conclusions, and devise/implement appropriate action plan
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  • Good business acumen, especially as it relates to Medicare
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  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive VoiceResponse (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
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Preferred Qualifications:

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  • Bachelors degree
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  • Medical/clinical background
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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)

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Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.

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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords: Clinical, consultant, medical, healthcare, STARS, Medicare, Boise, ID, Idaho

Categories

Posted: 2021-03-12 Expires: 2021-04-11

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Sr. Practice Performance Manager - Boise, ID - 917116

UnitedHealth Group
Boise, ID 83702

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