Value-based Program Specialist

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. 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 under CMS and commercial value-based contracts.

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
• 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, Power BI, Tableau, or 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
• Provider Education, Coaching & Workflow Optimization
  • Build and maintain strong, 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

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:

• 2+ years of value-based care 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
• Reside in the Lexington, KY market

Preferred Qualifications:

• Experience with HCC/RAF risk adjustment models
• Experience with HEDIS/STARS quality programs
• Experience in a clinic-based healthcare setting
• Proficiency with Excel and data manipulation
• Proven background in clinical performance improvement, care management, or provider relations

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

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 $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 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.