Job Information
UnitedHealth Group Physician Business Manager - Hybrid in South Texas in Corpus Christi, Texas
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
The Physician Business Manager role is responsible for the operations of the provider network in their assigned region and is the direct interface between the organization and the Contracted or Affiliated physician network. This position provides continuous education, support, training and troubleshooting to physicians and their staff. This role serves as the liaison between the organization’s central departments and the physician network to assist in the achievement of short and long-term operational and strategic goals. This role is instrumental in servicing the needs of independent, local/community based, physician practices within a certain geographic area.
This is a Hybrid position with 75% travel throughout the South Texas Region (Corpus Christi, Laredo, and the Rio Grande Valley area).
Primary Responsibilities:
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
Regularly meets with cross functional team to create, revise and adjust strategy for assigned Provider Groups to meet overall performance goals
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
Handles or ensures appropriate scheduling, agenda, materials, location, meals and minutes of provider meetings as needed
Represent WellMed/UHG by holding company sponsored Provider events (Summits, Virtual Town Hall Events, Learning Sessions)
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
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.
Required Qualifications:
1+ years of provider relations or managed care experience
Experience interfacing effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives and other health plan staff
Knowledge of Managed Care and Medicare programs
Willingness to travel throughout the South Texas region regularly
Preferred Qualifications:
Provider recruitment and contracting experience
Analytical and problem-solving experience with effective follow through
Risk Adjustment knowledge related to CMS reimbursement models
Knowledge of local provider community
Bilingual proficiency in English/Spanish
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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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