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Job Details


UnitedHealth Group

Practice Management Specialist, Behavioral Health - Telecommute in KY (107173927)

Management

Management

Yearly

No

Louisville, Kentucky, United States

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

The Behavioral Health Practice Management Specialist must demonstrate strong clinical and analytic skills, strong oral and written communication skills and must be comfortable working closely with senior leaders at high volume providers/groups/facilities. They will be responsible for the development of relationships with Community Mental Health Centers (CMHCs), groups, and facilities as well as other outpatient behavioral health entities. They will monitor their clinical effectiveness and efficiency, as well as compliance with contractual obligations. This Practice Specialist will work closely with Care Advocacy Operations, Affordability and Network Management teams to affect desired outcomes with facilities / programs as it relates primarily to treatment for our public sector membership.

The Practice Specialist will partner with outpatient providers/groups/facilities that operate outside of typical practice or billing patterns which will be subject to a specific set of interventions. The Practice Specialist’s role with these providers / groups / facilities will be to coordinate a strategic effort that includes Clinical Operations, Network Services, Program and Network Integrity, and Affordability with the goal of designing and delivering interventions aimed at addressing outlier practice patterns, while improving provider performance, quality and clinical outcomes. These interventions may include, but are not limited to, clinical audits and the development of performance improvement plans.

Primary Responsibilities:

  • Interface with senior leaders (e.g., CEO) at high volume facilities / providers/ groups
  • Communicate with facilities / providers / groups to initiate appropriate interventions focused on improvement of clinical outcomes and efficiency, improved quality of care, and appropriate billing and practice patterns
  • Support those high performing providers / groups / facilities such that performance remains at a high level
  • Identify outliers through analysis of clinical outcomes data, utilization / claims data
  • Conduct program audits and provide feedback results
  • Measure improvement of program performance over time
  • Modify interventions as appropriate
  • Initiate and monitor Performance Improvement Plans (PIPs) as appropriate to affect performance
  • Interface with other Optum departments including Care Advocacy, Affordability, Clinical Network Services, Program and Network Integrity, Legal, and Quality Improvement


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

Required Qualifications:

  • Licensed Master's Degree-Level Clinician in Psychology, Social Work, Counseling or Marriage or Family Counseling OR a Licensed Ph.D. level Psychologist, OR an RN with behavioral health experience
  • License must be active and unrestricted to practice at the independent level
  • 3+ years of utilization management experience in a managed care setting
  • Direct provider facing experience
  • Experience auditing medical records and reviewing results
  • Experience in interpreting and utilizing clinical data analytics in healthcare and use of that data to drive change
  • Knowledge of CPT / HCPCS codes
  • Solid analytical skills with knowledge of or willingness to use Microsoft Excel on a frequent basis
  • Dedicated space for home office set up and access to high speed internet services

Preferred Qualifications:

  • Direct clinical experience (Post Licensure)
  • Knowledge of public sector benefits, i.e., Medicaid
  • Capacity to provide solutions for non - standard and/or complex issues solutions
  • Excellent time management and prioritization skills
  • Ability to balance contractual and clinical considerations
  • Ability to establish and maintain strategic relationships with senior leadership teams
  • Solid communication skills, written and verbal, including ability to communicate effectively with and present to various levels of leadership
  • Candidates located in the state of Kentucky are highly preferred

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.

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