Practice Performance Manager - Medicare Consultant

Optum • Lincoln, NE

391d • Remote

About The Position

The Practice Performance Manager - Medicare Consultant at UnitedHealthcare is responsible for program implementation and provider performance management, focusing on improving the quality of care for Medicare Advantage members. This role involves building relationships with care providers, educating them on performance metrics, and identifying opportunities for performance improvement through data analysis and direct engagement. The position requires significant travel to meet with providers and facilitate ongoing training and support.

Requirements

• 5+ years of healthcare industry experience
• 2+ years of Medicare Advantage experience including Stars and Risk Adjustment
• 1+ years of provider-facing experience
• Intermediate level experience with Microsoft Office, particularly Excel and PowerPoint
• Currently a Certified Risk Adjustment Coder (CRC via AAPC) or Certified Professional Coder (CPC via AAPC) or Certified Coding Specialist - Physician-based (CCS-P via AHIMA) with the requirement to obtain both certifications within the first year in position.

Nice To Haves

• Registered Nurse
• Experience working for a health plan and/or within a provider office
• Experience with network and provider relations/contracting
• Experience retrieving data from EMRs
• Experience in management or coding position in a provider primary care practice
• Knowledge of clinical standards of care, preventive health, and Stars measures
• Knowledge of billing or claims submission and related actions

Responsibilities

• Function independently and travel across assigned territory to meet with providers to discuss UHC and Optum tools and UHC incentive programs for both risk adjustment and quality reporting.
• Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs, and ACOs.
• Develop comprehensive, provider-specific plans to increase HEDIS performance, facilitate risk adjustment suspect closure, and improve outcomes.
• Access PCOR to identify risk adjustment opportunities and utilize reporting sources to analyze data and prioritize gap and suspect closure.
• Conduct quarterly chart reviews and provide timely feedback to improve reporting.
• Coordinate and provide ongoing strategic recommendations, training, and coaching to provider groups on program implementation and barrier resolution.
• Lead regular Stars and risk adjustment specific JOC meetings with provider groups to drive continual process improvement.
• Provide reporting to health plan leadership on overall performance and gap closure.
• Facilitate/lead monthly or quarterly meetings, including report and material preparation.
• Collaborate with the interdisciplinary delivery team to coordinate care needs for members.
• Partner with providers to engage in UnitedHealthcare member programs.

Benefits

• Flexible work options including remote work
• Opportunities for professional development
• Performance recognition and rewards

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: No Education Listed