1+ months

Practice Performance Incentive Programs Manager - NYC, NY - 903717

New York, NY 10007
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  • Job Code
    903717

Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)

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The Practice Consultant is responsible for program implementation and 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, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results. The person will review charts (paper and electronic - EMR), identify gaps in care, and educate providers and offices to ensure they are coding to the highest specificity. Work is primarily performed at physician practices on a daily basis.

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Primary Responsibilities:

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  • Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and incentive programs focused on improving the quality of care for Medicare Advantage Members
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  • Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs
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  • Develop comprehensive, provider-specific plans to increase their HEDIS performance, facilitate risk adjustment gap closure and improve their outcomes
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  • Access PCOR to identify risk adjustment opportunities and utilize other available reporting sources including but not limited to (InSite, Spotlight, Provider Scorecard) to analyze data and prioritize gap closure, identify trends and drive educational opportunities
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  • Conduct chart review quarterly and provide timely feedback to provider to implement change on a go forward basis
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  • Coordinates and provides ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
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  • Training will include Stars measures (HEDIS/CAHPS/HOS/medication adherence), risk adjustment coding practices, and Optum program administration, use of plan tools, reports and systems
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  • Lead regular Stars and risk adjustment specific JOC meetings with provider groups to drive continual process improvement and achieve goals
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  • Provide reporting to health plan leadership on progress of overall performance, MAPCPi, MCAIP, gap closure, and use of virtual administrative resources
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  • Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
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  • Collaborates and communicates with the members health care and service with our interdisciplinary delivery team to coordinate the care needs for the member
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  • Partner with providers to engage in UnitedHealthcare member programs such as HouseCalls, clinic days, Navigate4Me
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  • Includes up to 75% local travel
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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 experience in the healthcare industry
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  • 1+ years of provider facing experience, including leading presentations
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  • Must be a CPC (Certified Professional Coder) or a CRC (Certified Risk Coder)
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  • Must be able to accommodate up to 75% local travel within the 5 boroughs of New York City
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  • Experience with network and provider relations/contracting
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  • Experience retrieving data from EMRs (electronic medical records)
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  • Experience building relationships with both clinical and non-clinical personnel
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  • Strong knowledge of Medicare Advantage, including STARS and Risk Adjustment
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  • Strong knowledge of clinical standards of care and preventive health
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  • MS Excel proficiency of at least intermediate
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  • Ability to use Excel to analyze and represent data
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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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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: New York City, New York, NY, Performance Manager, Incentive Programs, manager

Posted: 2020-12-19 Expires: 2021-02-18

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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Practice Performance Incentive Programs Manager - NYC, NY - 903717

UnitedHealth Group
New York, NY 10007

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