10 days old

Senior Physician Business Manager - Sr. PBM - Jacksonville, FL - 943476

Jacksonville, FL 32202
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  • Job Code
    943476

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieveyour lifes best work.(sm)

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This position functions as a subject matter expert in network operations. This position strives to bring consistency and experience to existing Physician Business Managers in the local market by analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. This position will organize and assist the local Physician Business Managers in achieving short and long term operational/strategic business goals/by developing, enhancing and maintaining operational information and models. They also develop, in conjunction with the local Director / Manager, and implement effective/strategic business solutions through research and analysis of data and business processes.

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General Profile:

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  • Analyzes risk pool and provider group performance to determine areas of focus or improvement opportunities
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  • Develops strategies to align contracted provider groups with company initiatives, goals (revenue and expense) and quality outcomes
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  • Create and develop action plans to achieve metrics in quality, coding and financial performance.
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  • Provides explanations and interpretations within area of expertise
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  • Provides daily direction and guidance to existing local Physician Business Managers and acts as the subject matter expert for their assign area
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Job Scope:

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  • Uses pertinent data and facts to identify and solve a range of problems through experience, research and collaboration
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  • Assists local Physician Business Managers with investigating non-standard requests and problems.
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  • Prioritizes and organizes assigned workload of local Physician Business Managers is able to meet deadlines while delivering the best outcomes possible
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  • Provides explanations, direction and information to others on topics within area of expertise
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  • Collaborates with local Medical Director(s) to monitor utilization trends and profit pools to assist with developing strategic plans to improve performance
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Primary Responsibilities:

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  • Proven analytical skills required to support, compile and report key information
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  • Drive processes and technology improvement initiatives that directly impact Revenue, HEDIS/STAR measures and Quality Metrics, using standard project methodology (requirements, design, test, etc.)
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  • Use data to identify trends, patterns and opportunities for the business and clients. Develop business strategies in line with company strategic initiatives
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  • Engage provider staff and providers in analysis and evaluation of functional models and process improvements; identify dependencies and priorities
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  • Evaluate and drive processes, provider relationships and implementation plans
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  • Produce, publish and distribute scheduled and ad-hoc client and operational reports relating to the development and performance of products
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  • Collaborate with other Physician Business Manager- Area Leads to foster teamwork and build consistency throughout the market
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  • Serves as a liaison to the health plan and all customers
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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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  • Bachelors degree in Business or Healthcare Administration or related field(4 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelors degree)
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  • 5+ years of experience in a related medical field or health plan setting (network management, contracting and/or recruitment, or provider relations)
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  • Knowledge of Managed Care and Medicare programs
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  • Exceptional interpersonal skills with ability to interface effectively internally with all levels of staff and externally with a wide range of people including physicians, office staff, hospital executives, medical groups, IPAs, the press and community organizations
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  • Proficiency in Microsoft Word, Excel and PowerPoint
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  • Solidverbal and written communication skills
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Preferred Qualifications:

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  • Bachelors degree in Business or Healthcare Administration or related field (3 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelors degree)
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  • Experience presenting group presentations and training
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  • Risk adjustment experience
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  • Risk Adjustment knowledge related to CMS reimbursement models
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  • Travel 50% of the time
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  • Sound work ethic & desire to succeed
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  • Ability to develop long-term positive working relationships
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  • Ability to communicate and facilitate strategic meetings with groups of all sizes
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  • Ability to communicate well with physicians, staff and internal departments
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  • Ability to act as a mentor to others
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  • Ability to sit down with medical groups of all sizes and develop joint action/work plans
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  • Ability to work independently, use good judgment and decision-making process
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  • Ability to conduct performance evaluation to identify performance measures or indicators and the actions needed to improve or correct performance, relative to the goals
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  • Ability to resolve complete problems and evaluate options to implement solutions
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  • Ability to adopt quickly to change in an ever-changing environment
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  • Sound business acumen, analytical, critical thinking, and persuasion skills
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  • Sound presentation skills, problem solving and ability to manage conflict and identify resolutions quickly
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Physical & Mental Requirements:

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  • Ability to lift up to 100 pounds
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  • Ability to push or pull heavy objects
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  • Ability to sit for extended periods of time
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  • Ability to stand for extended periods of time
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  • Ability to use fine motor skills to operate office equipment and/or machinery
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  • Ability to properly drive and operate a company vehicle
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  • Ability to receive and comprehend instructions verbally and/or in writing
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  • Ability to use logical reasoning for simple and complex problem solving
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  • Ability to work under stressful conditions and/or irregular business hours
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Careers with WellMed.Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to doyour life's best work.(sm)

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WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

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Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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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OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Job keywords: Senior Physician Business Manager, Network Management, Contracting, Recruitment, Provider Relations, Managed Care, Medicare, IPA, Jacksonville, FL, Florida

Posted: 2021-07-15 Expires: 2021-08-14

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.

Sponsored by:
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Senior Physician Business Manager - Sr. PBM - Jacksonville, FL - 943476

UnitedHealth Group
Jacksonville, FL 32202

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