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Optum - Nashville, TN
posted 2 months ago
About the position
The Practice Management Specialist at UnitedHealth Group is responsible for enhancing clinical performance and compliance within high-volume healthcare facilities and groups. This role involves developing relationships with providers, monitoring clinical effectiveness, and implementing strategic interventions to improve outcomes for members. The Specialist collaborates with various departments to ensure adherence to clinical processes and contractual obligations, while also supporting high-performing facilities to maintain their standards.
Responsibilities
- Interface with senior leaders at high volume facilities/groups or directly with providers.
- Communicate with facilities/groups/providers to initiate appropriate interventions focused on improvement of clinical outcomes and efficiency.
- Support high performing facilities and providers to maintain performance levels.
- Identify outliers through analysis of clinical outcomes data, utilization/claims data, and compliance with care advocacy protocols.
- Measure improvement of program/provider performance over time.
- Monitor and report effectiveness of interventions and modify as appropriate.
- Initiate and monitor Performance Improvement Plans (PIPs) as necessary.
- Interface with other Optum departments including Clinical Operations, Provider Relations and Contracting, Legal, and Program and Network Integrity.
Requirements
- Licensed Master's degree-level clinician in Psychology, Social Work, Counseling, or Marriage or Family Counseling, Licensed Ph.D. level Psychologist, or Registered Nurse (Licenses must be independent, active and unrestricted).
- 3+ years of Managed Care and/or Utilization Review experience in a Managed Care setting.
- Solid knowledge of CPT/HCPCS codes.
- Proven solid analytical skills with knowledge of or willingness to learn analytics software such as Microsoft Excel.
- Proven solid communication skills, both written and verbal.
- Solid computer skills at the intermediate level, proficiency with MS Office.
- Proven ability to balance contractual and clinical considerations.
- Demonstrated excellent time management and prioritization skills.
- Proven ability to establish and maintain strategic relationships with leadership teams.
Benefits
- Flexible remote work options for Tennessee residents.
- Opportunities for professional development and career growth.
