Provider Relations Advocate/Physician Business Manager - Laredo, TX

    • Nuevo Laredo, Mexico

Position Description

The more you do, the more you learn. And as you learn you find new doors opening that challenge you to bring your best. This Provider Relations Advocate role with UnitedHealth Group will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. We're building better, more effective provider networks every day. In this role, you'll use your strong customer service orientation and knowledge of insurance claims to serve as an advocate for providers in our networks. As you do, you'll discover the impact you want and the resources, backing and opportunities that you'd expect from a Fortune 6 leader.

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.

Primary Responsibilities:

  • Educate 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 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.
  • 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 ongoing education to providers and their staffs on healthcare delivery products, health plan partnerships, processes 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.
  • Conducts provider meetings to share and discuss economic data, troubleshoots for issue resolution, and implements an escalation process for discrepancies.
  • Collaborates with provider groups to develop, execute and monitor performance and patient outcomes improvement plans.
  • Collaborates with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs.
  • Handles or ensures appropriate scheduling, agenda, materials, location, meals and minutes of provider meetings as needed.
  • Collaborates with contracting team to ensure provider data is correct and Provider directories include any needed updates. Completes Practitioner Data Forms and Provider Change Forms as needed.
  • Represent WellMed/UHG by holding company sponsored Provider events (Summits, Learning Sessions)
  • Provides information and participate in management meetings as requested.
  • Regularly meets with cross functional team to create, revise and adjust strategy for assigned Provider Groups to meet overall performance goals.
  • Provider support to maintain and develop ongoing value related to the WellMed Value Proposition.
  • Introduce and advocate company resources to facilitate practice optimization.
  • Identifies at risk situations and develops a plan for escalation and corrective action.
  • Performs all other related duties as assigned.

Required Qualifications:
  • Associate's degree in related field required. (2 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a Associate's degree)
  • 3+ 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
  • Excellent analytical and problem solving skills with effective follow through
  • Strong verbal and written communication skills
  • Solid knowledge of local provider community

Preferred Qualifications:
  • Bachelor's 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
  • Provider recruitment and contracting experience

The health system is moving ahead. You can too as you help us build new levels of provider network performance. Join us. Learn more about how you can start doing your life's best work.(sm)

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.

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.

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.

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