Value-Based Program Specialist

Value-Based Program Specialist

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

The Value-Based Program Specialist is responsible for driving value-based care performance across assigned provider practices by supporting practices with the closure of care gaps, delivering program gap notifications, performing patient outreach, and producing actionable performance reports. This role blends data analysis with frontline provider engagement-educating, coaching, and operationalizing workflows that improve quality, documentation accuracy, patient outcomes, and financial performance. The role also serves as a consultative partner to providers and practice staff by building solid working relationships, proactively identifying performance improvement opportunities through data analysis and collaboration with subject matter experts, helping implement provider-specific action plans to improve outcomes, and supporting provider performance management tied to designated provider metrics, including quality gap closure and coding accuracy.

This is a field-based position based in Lexington, KY.

Primary Responsibilities:

Care Gap Identification & Closure

• Identify, prioritize, and drive closure of quality care gaps (e.g., AWV, preventive screenings, chronic condition monitoring) through EMR review, data reconciliation, pre visit planning, and coordinated workflows with practice staff and providers
• Deliver timely, actionable gap-in-care and documentation notifications to providers and practice leadership; track acknowledgement, follow-up action, and resolution through established tasking and report mechanisms

Quality Program Execution

• Manage end-to-end workflows supporting value-based care programs (documentation review, chart retrieval, data exchange, and submission) to ensure accurate coding, compliance documentation and program success
• Support chart collection, data entry, and medical record retrieval activities needed to validate quality measure completion and close documentation gaps

Patient Outreach & Care Coordination

• Conduct targeted outbound patient outreach to support targeted appointment scheduling, care access, and gap closure; identify and escalate barriers to the care team and coordinate services as needed

Performance Reporting & Analytics

• Create, maintain, and distribute accurate clinical performance reports (quality, risk adjustment, utilization, and cost trends) using tools such as Excel and payor platforms; tailor insights for provider, practice, and leadership audiences
• Analyze CMS, HEDIS, STAR, and payer data to identify trends, root causes, and improvement opportunities; translate analytics into clear, actionable recommendations and support execution and follow-through
• Provide reporting to leadership on overall performance, care gap closure progress, and key improvement initiatives, and prepare reports and supporting materials for monthly or quarterly performance meetings as needed

Provider Education, Coaching & Workflow Optimization

• Build and maintain solid, consultative relationships with providers, practice leaders, and internal partners to sustain performance
• Educate and coach physicians, coders, and practice staff on CMS quality programs, HCC/RAF methodology, documentation specificity, coding best practices, and efficient workflows; provide targeted feedback and measurable follow-up
• Develop provider-specific performance improvement plans, facilitate regular provider performance meetings to drive continuous improvement, and coordinate internal subject matter experts and resources to support provider education, barrier resolution, and workflow optimization

You'll 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.

Required Qualifications:

• 3+ years of healthcare industry experience
• 1+ years of HEDIS STARs experience
• Proven knowledge of value-based payment models
• Proven solid communication and provider engagement skills
• Ability to travel up to 60% in the eastern KY market
• Driver's License and access to reliable transportation
• Reside in the Lexington, KY area

Preferred Qualifications:

• 1+ years of experience working for a health plan, provider's office
• Experience in managed care working with network and provider
• Experience with HCC/RAF risk adjustment models
• Experience with HEDIS/STARS quality programs
• Experience in a clinic-based healthcare setting
• Solid knowledge of electronic medical record systems
• Medical/clinical background
• Proficiency with Excel and data manipulation

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. 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.

UnitedHealth Group is an Equal Employment Opportunity employer and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.