Practice Performance Manager – St. Louis, MO

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

This role is responsible for 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, an to proactively identify performance improvement opportunities through analysis and discussion with subject matter experts. This position does not entall any direct member care* nor does any case management occur. (*with the exception of participating in health fairs and/or health screenings where member contact could occur)

If you are located in the greater St. Louis, MO area, you will have the flexibility to work remotely* as you take on some tough challenges. 

Primary Responsibilities:

• The Practice Performance Manager 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 omprovement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results
• Functioning Independently, travel across assigned territory to meet with providers to discuss UHG tools and programs focused on improving the quality of care for Medicare Advantage Members
• Execute applicable provider incentive programs for health plan
• Establish positive,long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
• Develop comprehensive, provider-specific plans to increase their HEDIS performance and improve their outcoms
• Provide ongoing strategic recommendations, training and coaching to provider groups on program implementtation and barrier resolution
• Act as lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation. Training will include
• Stars measures (HEDIS/CAHPS/HOS/med adherence), and Optum program administration, use of plan tools, reposts and systems
• Coordinate and lead Star-specific JOC meetings with provider groups with regular frequency to drive continual process improvement and achieve goals
• Provide reporting to health plan leadership on progress of overall pervormance gap closure, and use of virtual administrative resource
• Facillitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
• Provide suggestions and feedback to Optum and health plan
• Work collaboratively with health plan market leads to make providers aware of Plan-sponsored initiatives designed to assist and empower members in closing gaps
• Participate within department campaigns to improve overall quality improvements within measure star ratiings or contracts
• Work internally with leadership on adhoc projects, initiatives, and sprints to address measure star ratings and increase overall measure performance
• Create strategy and action plans for targeted provider groups to increase healthcare delivery, star ratings, and maximize on gap closures
• Weekly commitment of 75% travel for business metings (including client/health plan partners and provider meetins) and 25% remote work

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:

• 5+ years of healthcare industry experience
• 3+ years of experience working for a health plan and/or for a providers office
• 1+ years of STARs experience
• Intermediate level experience Microsoft Office experience including Excel with and PowerPoint
• Proven solid communication and presentation skills
• Proven solid relationship building skills with clinical and non-clinical personnel
• Proven weekly commitment of up to 75% travel for business meetings (including client/health plan partners and provider meetins) and 25% remote work
• Reside in the in the greater St. Louis, MO area and have the ability to travel to Southern, IL

Preferred Qualifications:

• Consulting experience
• Experience in managed care working with network and provider relations/contracting
• Medical/clinical background
• Solid knowledge of electronic medical record systems
• Solid knowledge of the Medicare market
• Knowledge base of clinical standars of care, preventive health, and Stars measures
• Microsoft Office specialist with exceptional analytical and date representation expertise; Advanced Excel, Outlook, and Powerpoint skills
• Proven problem solving skills
• Proven financial analytical background within Medicare Advantage plans (Rish Adjustment/STARS Calculation models)

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. 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.

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.