- Educate Providers to ensure they have the tools they need to meet Quality, Risk adjustment, growth (as appropriate) and Total Medical Cost goals per business development plans
- Ensures Providers have in depth understanding of WellMed Model of Care to include, but not limited to, contractual obligations, program incentives and patient care best practices
- Conduct detailed analysis of various reports by tracking and trending data to develop a strategic plan to ensure performance goals are achieved
- Ensures the overall strategic plan incorporates interventions with internal departments or subject matter experts, external vendors, and others as needed
- Participates in creation and execution of a local network development plan to assure network adequacy as needed
- Works at the direction of their assigned leader to recruit/contract providers ensuring network adequacy
- Conducts new provider orientations and ongoing education to providers and their staffs on healthcare delivery products, health plan partnerships, processes and compensation arrangements
- Maintains open communication with providers to include solutions for resolution and closure on health plan issues related to credentialing, claims, eligibility, disease management, utilization management, quality and risk adjustment programs
- Conducts provider meetings to share and discuss economic data, troubleshoots for issue resolution, and implements an escalation process for discrepancies
- Collaborates with provider groups to develop, execute and monitor performance and patient outcomes improvement plans
- Collaborates with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs
- Handles or ensures appropriate scheduling, agenda, materials, location, meals and minutes of provider meetings as needed
- Collaborates with contracting team to ensure provider data is correct and Provider directories include any needed updates. Completes Practitioner Data Forms and Provider Change Forms as needed
- Represent WellMed/UHG by holding company sponsored Provider events (Summits, Learning Sessions)
- Provides information and participate in management meetings as requested
- Regularly meets with cross functional team to create, revise and adjust strategy for assigned Provider Groups to meet overall performance goals
- Provider support to maintain and develop ongoing value related to the WellMed Value Proposition
- Introduce and advocate company resources to facilitate practice optimization
- Identifies at risk situations and develops a plan for escalation and corrective action
- Performs all other related duties as assigned
- Provider relations or managed care experience
- MS Office experience (Word, Excel, Outlook, PowerPoint)
- Willing or ability to work 75% - 80% out in the field
- Willing or ability to work onsite in an office environment
- 3+ years of provider relations or managed care experience
- Professional provider relations experience involving physicians and administrative staff
- Provider recruitment and contracting experience
- Advanced level of knowledge and experience in Excel
- Solid knowledge of local provider community
- Proven presentation skills to small and large groups
- Proven exceptional interpersonal skills with ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives and other health plan staff
- Proven excellent analytical and problem-solving skills with effective follow through
- Proven solid verbal and written communication skills
- Ability to lift up to 25 pounds
- Ability to sit for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
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Physician Business Manager - McAllen, United States - UnitedHealth Group
Description
Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.The Physician Business Manager is responsible for developing, maintaining and servicing a high quality, marketable and satisfied provider network within an assigned geographic area.Key responsibilities include recruitment and contracting, education and servicing of assigned providers.The Physician Business Manager helps assigned Providers operate successfully within our healthcare delivery model by providing strategic planning and tools to meet goals.This position is expected to build and sustain solid working relationships with cross functional departments, vendors, local sales, and assigned Providers. The Physician Business Manager is accountable for overall performance and profitability for their assigned groups as well as ownership and oversight to provide redirection as appropriate.
If you are located in McAllen, TX, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
Required Qualifications:
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: 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.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Physician Business Manager professionals in McAllen
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Gina Morin
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Danica Gonzalez
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