Care and Value Analyst or Consultant

Explore opportunities with WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will be part of a team who shares your passion for helping people achieve improved health outcomes. Explore rewarding opportunities for physicians, clinical staff and non-patient-facing roles. Join us and discover the meaning behind Caring. Connecting. Growing together.

The Care and Value Optimization Consultant (CVOC) researches and investigates critical business problems through quantitative analyses of revenue, utilization metrics, healthcare costs, membership trends, and quality and risk adjustment data. The CVOC 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. The CVOC partners with the Employed, Contracted/Affiliated, Supportive Care, Specialists, and Enterprise Care and Value leadership to support Care and Value initiatives and strategies across Greater Texas. The CVOC also builds relationships with the staff of the teams mentioned above and presents on their findings in weekly, monthly, and quarterly meetings.

Primary Responsibilities:

• Demonstrate understanding of Enterprise and Greater Texas Care and Value goals and be the subject matter expert for all things Care and Value in their assigned market
• Conducts analysis on Care and Value reporting and presents these findings to operational leadership and staff
• Assist with Employed efforts
  • Attends focus clinic meetings for those clinics off target in utilization 
  • Conducts training on existing and new Care and Value reporting
  • Prepares and presents during Quarterly Strategic Meetings and guides the conversation on how to improve metrics that are not on target
• Assist with Contracted/Affiliated efforts
  • Market contracting and strategy 
  • Assist PBMs with financial education, meeting presentations, and identifying areas of opportunities 
  • Corrective action plan for pools
  • Conducts training on existing and new Care and Value reporting
  • Analysis of yearly contracted pool structure
    • Pool movement and restructuring impact
    • Compliance of pool criteria and structure
  • Prepares and presents in Quarterly Pool Meetings to large groups of Contracted/Affiliated providers and staff
• Monitors and reviews metric performance for Hospital and Specialty Joint Operating Committees (JOC)
• Partners with the Supportive Care team in the market to strategize on our highest risk patients
• Partner with market dyads on market-wide initiatives
• Develop tracking metrics and perform analysis of special projects 
• Monthly or weekly report card/analysis packet to present at monthly market Care and Value meetings
• 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
• Knowledge of Managed Care and Medicare programs
• Understanding of the complexity of Member healthcare, claims
• Proficient in MS Excel and/or equivalent data capture/reporting tools
• Proven ability to communicate and facilitate strategic meetings with groups of all sizes
• Proven solid verbal and written communication skills 
• 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 50% within assigned market
• Driver's License and access to reliable transportation

Preferred Qualifications:

• 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

Physical & Mental Requirements: 

• Ability to lift up to 25 pounds
• Ability to push or pull heavy objects using up to 25 pounds of force
• Ability to sit for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 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 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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law 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, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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