Care Value Optimization Consultant – Milwaukee, WI

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

 

The Care Value and Optimization Consultant (CVO) Consultant researches and investigates critical business problems through quantitative analyses of revenue, utilization metrics, healthcare costs, membership trends, and quality and risk adjustment data. The CVO Consultant provides management with statistical findings and conclusions and partners with stakeholders to identify areas of opportunity to improve the financial performance of clinics and risk pools. CVO Consultant also develop recommendations and strategies and communicates findings to leadership and operations teams to help implement corrective action plans.

 

Primary Responsibilities:  

• Demonstrate understanding of a provider’s business goals, contracting, performance metrics/scorecard, industry trends, and business model
• Coaches and provides the translation of financial data to guide action
• Assist with contracted and affiliated efforts
  • Market contracting strategy
  • Assist Physician Business Managers (PBMs) with financial education, meeting presentations, and identifying areas of opportunities
  • Corrective action plan for pools
  • Analysis of yearly contracted pool structure
    • Pool movement and restructuring impact
    • Compliance of pool criteria and structure
• Monitors and reviews metric performance for Hospital and Specialty Joint Operating Committees (JOC).
• Conduct financial and (Health Care Economics) HCE training for new providers and staff
• Partner with market dyads on market-wide initiatives
• Act as SME over market financials and support leadership on strategic projects and decisions
• Develop tracking metrics and perform analysis of special projects
• Monthly or weekly report card/analysis packet
• Support market meetings: Strategic meetings, Contracted Pool meetings, and Monthly Market Success meetings (MSM) and/or Grand Rounds (GR)
• Performs all other related duties as assigned

   

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 general healthcare data analysis experience
• 2+ years of experience in a reporting and analytical role
• Experience working directly with clinicians
• Understanding of the complexity of Member healthcare, claims
• Knowledge of Managed Care and Medicare programs
• Proficient in MS Excel and/or equivalent data capture/reporting tools
• Proven solid verbal and written communication skills 
• Proven ability to communicate and facilitate strategic meetings with groups of all sizes
• Proven ability to work independently, use good judgment and decision making process
• Proven ability to conduct performance evaluation to identify performance measures or indicators and the actions needed to improve or correct performance, relative to the goals
• Ability to travel up to 75% within assigned market

Preferred Qualification:    

• 3+ years of experience in a clinical setting
• Risk Adjustment knowledge related to CMS reimbursement models
• Proven ability to act as a mentor to others

 

     

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: 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.

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