Hybrid Care and Value Optimization Consultant Orlando FL

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.

The Care and Value Optimization Consultant (CVOC) researches and investigates critical business problems through quantitative analyses of revenue, utilization metrics, healthcare costs, membership trends, and quality and risk adjustment data. The CVOC provides management with statistical findings and conclusions and partners with stakeholders to identify areas of opportunity to improve the financial performance of clinics and risk pools. The CVOC partners with the Care Management (CM) leadership to support CM related strategic projects, tracking of metrics and analysis of reporting. The CVOC also develops recommendations and strategies and communicates findings to leadership and operations teams to help implement corrective action plans.

Primary Responsibilities:

• Demonstrate understanding of a provider's business goals, contracting, performance metrics/scorecard, industry trends, and WellMed business model
• Coaches and provides the translation of financial data to guide action.
• Assist with contracted and affiliated efforts
  • Market contracting strategy
  • Assist PBMs with financial education, meeting presentations, and identifying areas of opportunities
  • Corrective action plan for pools
  • Analysis of yearly contracted pool structure

• Pool movement and restructuring impact
• Compliance of pool criteria and structure

• 3+ years of general healthcare data analysis experience
• 2+ years of experience in a reporting and analytical role
• Understanding of the complexity of Member healthcare, claims
• Knowledge of Managed Care and Medicare programs
• Proficient in MS Excel and/or equivalent data capture/reporting tools
• Proven solid verbal and written communication skills
• Demonstrated ability to communicate and facilitate strategic meetings with groups of all sizes
• Demonstrated ability to work independently, use good judgment and decision making process
• Demonstrated ability to conduct performance evaluation to identify performance measures or indicators and the actions needed to improve or correct performance, relative to the goals
• Demonstrated ability to travel up to 75% within assigned market

• 3+ years of experience in a clinical setting
• Risk Adjustment knowledge related to CMS reimbursement models
• Demonstrated ability to act as a mentor to others

• Ability to lift up to 25 pounds
• Ability to push or pull heavy objects using up to 25 pounds of force
• Ability to sit for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving