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Senior Provider Business Manager - Optum job in Atlanta at UnitedHealth Group

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Senior Provider Business Manager - Optum at UnitedHealth Group

Senior Provider Business Manager - Optum

UnitedHealth Group Work From Home, GA Full Time

***** TELECOMMUTE WITH RESTRICTIONS: Candidates must reside in Indiana with a preferrence for the central Indiana market. 

OptumCare is a rapidly growing national, integrated health care organization that helps physicians and other providers deliver the right care at the right time in the right setting.  We design and manage delivery systems in markets where we can achieve the Quadruple Aim — a better patient experience, higher quality care, lower costs, and a better experience for providers. With our expertise and resources, we are on the front lines transforming the health care delivery system to help improve the overall health of patients and communities.

This physician led, patient centric, and data driven business creates value by delivering and facilitating care across the full continuum through high performing networks comprised of owned, managed and contracted physicians, advanced practitioners and other providers. Our system impact extends across physicians, specialty care, urgent care, home health, post-acute transitions, complex care in skilled nursing facilities and palliative care.

Job Overview

The Provider Business Manager (PBM) has geographic responsibility for the quality and economic performances of the physician practice with the goal of developing a high performing provider network within the State of Indiana.  This includes analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning.  Along with engaging the provider members through the on-boarding process with an effective transition from the Network Development and Engagement area.  The PBM will develop and sustain a strong day-to-day relationship with stakeholders, the physician and office staff to effectively implement the business solutions developed by Optum leadership team.  The PBM is accountable for overall performance and profitability for their assigned groups as well as ownership and oversight to provide redirection as appropriate and approved.  The responsibilities of this position include capabilities in the following areas: strategic planning and analysis; understanding of HEDIS, Star ratings, RAF Score and coding; highly developed communication skills; and the ability to develop clear action plans and drive process.  

All positions of Optum includes working collaboratively with the Medical Director to achieve improved performance on the elements of the triple aim consisting of total cost of care management, quality outcomes, and patient experience for our customers; employers and patients.

Primary Responsibilities

  • Aligns contracted providers with initiatives, goals (revenue/expense) and quality outcomes. 
  • Uses pertinent data and facts to identify and solve a range of operational issues within the provider practices. 
  • Builds strategic relationships and partnerships with providers to work as a team in order to provide improved value to our patients and develop a competitive differentiation to position us as the value based organization of choice.
  • Maintains open communication with providers to include solutions for resolution and closure on health plan issues related to credentialing, eligibility, disease management, utilization management, quality and risk adjustment programs.
  • Drive processes and technology improvement initiatives that directly impact Revenue, HEDIS/STAR measures and Quality Metrics. 
  • Engage providers and staff in the analysis and evaluation of functional models and process improvements. 
  • Identifies and evaluates business opportunities and maintain contacts with healthcare providers to build innovative partnerships and programs that deliver value in new ways. 
  • Provides assistance and guidance on the development of collateral material that demonstrates the value proposition that ensure improved patient-centered care, including appropriate preventive services, referral management, wellness initiatives, and population health management.

Required Qualifications

  • Three or more years of provider relations or managed care experience.
  • Exceptional interpersonal skills with ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives and other health plan staff.
  • Excellent analytical and problem solving skills with effective follow through.
  • Strong verbal and written communication skills.
  • Solid knowledge of local provider community.
  • Ability to travel regularly to provider offices in the designated market
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance. 

Preferred Qualifications

  • Bachelor's degree in Healthcare, Business Administration or related field OR comparable combination of education and work experience.
  • Medical practice manager
  • Presentation skills to small and large groups
  • Professional provider relations experience involving physicians and administrative staff
  • Understanding of IPAs, Clinically Integrated Networks, Medicare Shared Savings Programs, capitation/value-based contracting, and narrow networks.
  • Experience with private and employed physician models and care redesign including care management and patient care.
  • Microsoft Office/Excel proficiency

Proof of immunity to vaccine-preventable diseases is an employment requirement.  

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

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.

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

Job Keywords: Provider relations, physician relations, provider business manager, physician business manager, network contracting, physician recruitment, provider recruitment, business development, UnitedHealth Group, Optum, OptumCare, Indianapolis, Indiana

 

Recommended Skills

  • Healthcare Effectiveness Data And Information Set
  • Managed Care
  • Credentialing
  • Medicare
  • Utilization Management
  • Interpersonal Skills
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