1+ months

Physician Business Manager, WellMed - Corpus Christi, TX

Corpus Christi, TX 78401
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  • Job Code
    838721

The more you do, the more you learn. And as you learn you find new doors opening that challenge you to bring your best. This provider relations role with UnitedHealth Group will call on your knowledge, your energy, and your commitment to making health care work more effectively for more people. We're building better, more effective provider networks every day. In this role, you'll use your strong customer service orientation and knowledge of insurance claims to serve as an advocate for providers in our networks. As you do, you'll discover the impact you want and the resources, backing, and opportunities that you'd expect from a Fortune 5 leader.

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 strong 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.

 

Primary Responsibilities:

  • 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
  • Ensure 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
  • Ensure the overall strategic plan incorporates interventions with internal departments or subject matter experts, external vendors, and others as needed
  • Participate in creation and execution of a local network development plan to assure network adequacy as needed
  • Work at the direction of their assigned leader to recruit / contract providers ensuring network adequacy
  • Conduct new provider orientations and ongoing education to providers and their staffs on healthcare delivery products, health plan partnerships, processes, and compensation arrangements
  • Maintain 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
  • Conduct provider meetings to share and discuss economic data, troubleshoot for issue resolution, and implement an escalation process for discrepancies
  • Collaborate with provider groups to develop, execute, and monitor performance and patient outcomes improvement plans
  • Collaborate with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs
  • Handle or ensure appropriate scheduling, agenda, materials, location, meals, and minutes of provider meetings as needed
  • Collaborate with contracting team to ensure provider data is correct and Provider directories include any needed updates
  • Complete Practitioner Data Forms and Provider Change Forms as needed
  • Represent WellMed / UHG by holding company sponsored Provider events (Summits, Learning Sessions)
  • Provide information and participate in management meetings as requested
  • Regularly meet 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
  • Identify at risk situations and develop a plan for escalation and corrective action

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Posted: 2019-08-23 Expires: 2019-09-23

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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Physician Business Manager, WellMed - Corpus Christi, TX

UnitedHealth Group
Corpus Christi, TX 78401

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