Clinical Practice Performance Consultant - Dallas/Ft Worth, TX Markets

About the role

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. This Practice Performance Manager role is responsible for program implementation and provider performance management tracked by designated provider metrics, including 4 STAR gap closure and coding accuracy. This is a field-based role requiring you to reside within a commutable distance of Dallas/Ft Worth, TX. You will have the flexibility to work remotely as well as in the field.

Responsibilities

• Work directly with care providers to build relationships, ensure effective education and reporting, and proactively identify performance improvement opportunities through analysis and discussion with subject matter experts.
• 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 the 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 outcomes.
• Provide ongoing strategic recommendations, training, and coaching to provider groups on program implementation and barrier resolution.
• Act as lead to pull necessary internal resources together for effective provider education, coaching, and consultation, including Stars measures (HEDIS/CAHPS/HOS/med adherence) and Optum program administration.
• Coordinate and lead Stars-specific JOC meetings with provider groups to drive continual process improvement and achieve goals.
• Provide reporting to health plan leadership on progress of overall performance, gap closure, and use of virtual administrative resources.
• Facilitate/lead monthly or quarterly meetings, including report and material preparation.
• Provide suggestions and feedback to Optum and the 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 in department campaigns to improve overall quality within measure star ratings or contracts.
• Work internally with leadership on ad-hoc 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 gap closures.
• Includes up to 75% local travel.

Requirements

• 5+ years of healthcare industry experience.
• 3+ years of experience working for a health plan and/or for a provider's office.
• 1+ years of STARs experience.
• Solid knowledge of electronic medical record systems.
• Solid knowledge of the Medicare market.
• Knowledge base of clinical standards of care, preventive health, and Stars measures.
• Experience in managed care working with network and provider relations/contracting.
• Solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models).
• Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills.
• Must be able to travel within local territory up to 75%.

Preferred Qualifications

• Bachelor's Degree or equivalent work experience.
• Medical/clinical background.
• Consulting experience.
• Solid problem-solving skills.
• Solid communication and presentation skills.
• Solid relationship-building skills with clinical and non-clinical personnel.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

Pay

The salary for this role will range from $72,800 - $130,000 annually based on full-time employment, considering factors such as local labor markets, education, work experience, and certifications.