Physician Business Manager - El Paso, TX
Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work. (sm)
WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic stat that understands and care about the patient's health. WellMed's proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.
The Physician Business Manager is responsible for developing, maintaining and servicing a high quality, marketable and satisfied provider network within an assigned geographic area. Key responsibilities include recruitment and contracting, education and servicing of assigned providers. The Physician Business Manager helps assigned Providers operate successfully within our healthcare delivery model by providing strategic planning and tools to meet goals. This position is expected to build and sustain strong working relationships with cross functional departments, vendors, local sales, and assigned Providers. The Physician Business Manager is accountable for overall performance and profitability for their assigned groups as well as ownership and oversight to provide redirection as appropriate.
- Educates Providers to ensure they have the tools they need to meet Quality, Risk adjustment, growth (as appropriate) and total medical cost goals per business development plans
- Ensures Providers have in depth understanding of AHN Care Model to include, but not limited to, contractual obligations, program incentives and patient care best practices
- Conducts detailed analysis of various reports by tracking and trending data to develop a strategic plan to ensure performance goals are achieved
- Ensures the overall strategic plan incorporates interventions with internal departments or subject matter experts, external vendors, and others as needed
- Participates in creation and execution of a local network development plan to assure network adequacy as needed
- Works at the direction of their assigned leader to recruit/contract providers ensuring network adequacy
- Conducts new provider orientations and collaborates with Executive Directors on ongoing education to providers and their staff on healthcare delivery products, health plan partnerships and compensation arrangements.
- Maintains open communication with providers to include solutions for resolution and closure on health plan issues related to credentialing, claims, eligibility, disease management, utilization management, quality and risk adjustment programs
- Collaborates with Executive Director and Lead Physician to conduct provider meetings to share and discuss economic data, identify and support best practices and escalates discrepancies for resolution, as needed
- Works with Executive Directors on all required PBM provider meetings. The PBM is responsible for the agenda, minutes of the meeting, any action items and information reported appropriately
- Collaborates with contracting team and payers to ensure provider data is correct and Provider directories include any needed updates. Completes Practitioner Data Forms and Provider Change Forms as needed
- Performs all other related duties as assigned
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Bachelor's degree (4+ years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor's degree
- Three or more years of provider relations or managed care experience
- Exceptional interpersonal skills with ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives and other health plan staff
- Intermediate proficiency in Microsoft Office suite
- Excellent analytical and problem solving skills with effective follow through
- Strong verbal and written communication skills
- Solid knowledge of local provider community
- Ability to travel within El Paso county
Bilingual in Spanish
- Undergraduate/graduate degree with a significant understanding of medical care financing and delivery systems, provider contracting, reimbursement arrangements and network management
- Presentation skills to small and large groups
- Professional provider relations experience involving physicians and administrative staff
- Knowledge of Medicare Advantage programs
- H EDIS / STAR rating experience
- Provider recruitment and contracting experience
- Some knowledge of claims coding
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 380,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
Job Keywords: Physician Business Manager, Provider Relations, Managed Care, El Paso, TX, Texas
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