Sr. Provider Engagement Specialist - Jackson, TN - Remote

Primary Responsibilities

• Data analysis required to support, compile and report key information
• Drive processes and technology improvement initiatives that directly impact Revenue, HEDIS/STAR measures and Quality Metrics, using standard project methodology (requirements, design, test, etc.)
• Use data to identify trends, patterns and opportunities for the business and clients. Develop business strategies in line with company strategic initiatives
• Engage provider staff and providers in analysis and evaluation of functional models and process improvements; identify dependencies and priorities
• Evaluate and drive processes, provider relationships and implementation plans
• Produce, publish and distribute scheduled and ad-hoc client and operational reports relating to the development and performance of products
• Collaborate with other Client Services leads to foster teamwork and build consistency throughout the market
• Serves as a liaison to the health plan and all customers
• Requires strong presentation skills, problem solving and ability to manage conflict and identify resolutions quickly
• Have the ability to communicate well with physicians, staff and internal departments

Essential Job Functions

• Analyze risk pool and/or provider group performance to determine areas of focus or improvement opportunities, to include performing analysis of financial statements and other metric-related report to determine areas of focus or improvement opportunities
• Develops strategies and create action plans that align provider pools and groups with company initiatives, goals (revenue and expense) and quality outcomes
• Drive processes and improvement initiatives that directly impact revenue, HEDIS/STAR measures and quality metrics, coding and documentation process and educational improvements
• Use and analyze data to identify trends, patterns and opportunities for the business and clients, and collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
• Collaborates with internal clinical services teams, alongside Client Services leaders, to monitor utilization trends and risk pools to assist with developing strategic plans to improve performance
• Affords provider groups with investigating standard and non-standard requests and problems, to include claims and member support services
• Maintains effective support services by working effectively with the Director of Client Services, Regional Medical Director, Clinical Services team, Operations and other corporate departments
• Demonstrate understanding of providers' business goals and strategies in order to facilitate the analysis and resolution of their issues
• Performs all other related duties as assigned

Required Qualifications

• 5+ years of experience in a related medical field or health plan setting (network management, contracting and/or recruitment, provider relations or in medical practice)
• Experience with Medicare health care operations including HEDIS, CMS reimbursement models, and Medicare Advantage
• Experience developing long-term positive working relationships
• Experience communicating and facilitating strategic meetings with groups of all sizes
• Experience working independently, using good judgment and decision-making
• Experience conducting performance evaluations to identify performance measures or indicators and the actions needed to improve or correct performance, relative to the goals
• Experience resolving complete problems and evaluating options to implement solutions
• Proficiency in Microsoft Word, Excel and PowerPoint
• Knowledge of state and federal laws relating to Medicare
• Reliable transportation and ability and willingness to travel, both locally in assigned territory and non-locally, as determined by business need up to 70%
• Permanent residence within a commutable distance to Jackson, TN

Preferred Qualifications

• 3+ years of Healthcare management experience
• Experience acting as a mentor to others
• Client Management experience

Pay and Benefits

• 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.
• UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
• Benefits
• Life Resources and support to focus on what matters most to you, in every facet of your life.
• Emotional Education, tools and resources to help you reduce and manage stress, build resilience and more.
• Physical Health plans and other coverage to support wellness for you and your loved ones.
• Financial Benefits for today and to help you plan for the future, including your retirement.