Physician Business Mgr (Contracting / Provider Rel) - Tyler, TX
- Long Branch, TX
Note: The successful candidate will live in Tyler, TX or in the Upper East Texas area.
The Physician Business Manager with WellMed 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.
- Educate providers to ensure that they have the tools they need to meet quality, risk adjustment, growth (as appropriate), and total medical cost goals per business development plans
- Ensure providers have in-depth understanding of WellMed Model of Care to include, but not limited to, contractual obligations, program incentives, and patient care best practices
- Conduct detailed analysis of various reports by tracking and trending data to develop a strategic plan to ensure performance goals are achieved
- Ensure the overall strategic plan incorporates interventions with internal departments or subject matter experts, external vendors, and others, as needed
- Participate in creation and execution of a local network development plan to assure network adequacy as needed
- Work at the direction of your assigned leader to recruit/contract providers, ensuring network adequacy
- Conduct new provider orientations and ongoing education to providers and their staffs on healthcare delivery products, health plan partnerships, processes, and compensation arrangements
- Maintain 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
- Conduct provider meetings to share and discuss economic data, troubleshoot for issue resolution, and implement an escalation process for discrepancies
- Collaborate with provider groups to develop, execute, and monitor performance and patient outcomes improvement plans
- Collaborate with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs
- Handle or ensure appropriate scheduling, agenda, materials, location, meals, and minutes of provider meetings as needed
- Collaborate with contracting team to ensure provider data is correct and provider directories include any needed updates
- Complete Practitioner Data Forms and Provider Change Forms as needed
- Represent WellMed / UHG by holding company sponsored provider events (summits, learning sessions)
- Provide information and participate in management meetings as requested
- Regularly meet with cross functional team to create, revise, and adjust strategy for assigned provider groups to meet overall performance goals
- Provide support to maintain and develop ongoing value related to the WellMed Value Proposition
- Introduce and advocate company resources to facilitate practice optimization
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.
- High school diploma or equivalent
- 3+ years of provider relations or managed care experience
- 1+ years of contracting 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
- Experience with making presentations to both small and large groups
- Intermediate proficiency with MS Suite (including Word, PowerPoint, and Excel)
- Access to reliable transportation and ability to travel up to 75% within East Texas area
- Ability to work evenings and weekends on occasion based on business needs
- Advanced degree
- Understanding of medical care financing and delivery systems, provider contracting, reimbursement arrangements, and network management
- Established knowledge of local provider community
- Excellent analytical and problem solving skills with effective follow through
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)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: health care, healthcare, managed care, Medicare, provider relations, provider network, provider education, quality, risk adjustment, network development, WellMed, travel, Austin, TX, Texas
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