28 days old

Sr. Provider Relations Advocate - Polk County, FL - 937930

Polk County, FL
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  • Job Code
    937930

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 achieve your 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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Primary Responsibilities:

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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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  • 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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  • Solid analytical skills required to support, compile and report key information
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  • Drive processes and technology improvement initiatives that directly impact Revenue,
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  • 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
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  • 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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  • Requires strong presentation skills, problem solving and ability to manage conflict and identify resolutions quickly
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  • Ability to communicate well with physicians, staff and internal departments
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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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  • Proficiency in Microsoft Word, Excel and PowerPoint
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  • Knowledge of Managed Care and Medicare programs
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  • Experience communicating and facilitating strategic meetings with groups of all sizes
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  • Solid business acumen, analytical, critical thinking and persuasion skills
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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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  • You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role
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Preferred Qualifications:

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  • Risk Adjustment knowledge related to CMS reimbursement models
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  • Strong verbal and written communication skills
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  • Ability to act as a mentor to others
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  • Ability to develop long-term positive working relationships
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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 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: Sr. Provider Relations Advocate, Provider Relations, Provider Advocate, Sr. PBM, Senior Physician Business Managers, healthcare, Polk County, FL, Florida

Posted: 2021-06-30 Expires: 2021-07-30

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. Provider Relations Advocate - Polk County, FL - 937930

UnitedHealth Group
Polk County, FL

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