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Practice Performance Manager - South Carolina




Sumter, South Carolina, United States

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.

This role is responsible for provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy. The person in this role is expected to work directly with care providers to build relationships, ensure effective education and reporting, and to proactively identify performance improvement opportunities through analysis and discussion with subject matter experts. The person will review charts (paper and electronic - EMR), look for gaps in care, perform telephonic assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention. Work is primarily performed at physician practices on a daily basis.

If you are located in South Carolina, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

  • Manage assigned practices to performance goals: 4 STAR gap closure and 90% of HCC covered
  • Work directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results
  • Functioning independently, travel across assigned territory to meet with providers to discuss UHG tools and programs focused on attestation completion, HCC coding and documentation accuracy and improving the quality of care for Medicare Advantage Members
  • Review HCC performance and conduct chart reviews as needed to share targeted coding and documentation education with providers
  • Facilitate and prepare for monthly meetings with practices, including report and material preparation
  • Provide suggestions and feedback to Population Health leadership team
  • Participate within department campaigns to improve overall quality improvements within measure star ratings or contracts
  • Work internally with leadership on adhoc projects, initiatives, and sprints to address measure star ratings and increase overall measure performance
  • Share reports with assigned practice leadership and providers and explain opportunity areas and operational steps for achievement
  • Work with practices to establish workflows for attestation completion and gap closure
  • Actively report challenges and barriers to practice performance with Senior PPM and collaborate on solutions
  • Proactively work on action plans for targeted provider groups to increase healthcare delivery, star ratings, and maximize on gap closures

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:

  • Bachelor’s degree or equivalent work experience
  • 3+ years of healthcare industry experience (Provider Office Operations, STARs Quality Improvement, HCC Coding Education, Provider Engagement/Liaison)
  • 1+ years of STARS or RAF experience
  • Knowledge base of clinical standards of care, preventive health, and Stars measures
  • Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint
  • Based in South Carolina
  • Ability to travel locally up to 75% within South Carolina ( mileage reimbursement provided)

Preferred Qualifications:

  • Certified Professional Coder (CPC) and/or Certified Risk Adjustment Coder (CRC)
  • Experience in managed care working with network and provider relations and engagement
  • Consulting experience
  • Knowledge of electronic medical record systems
  • Knowledge of the Medicare market
  • Medical/clinical background
  • Financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
  • Proven solid communication and presentation skills
  • Proven solid relationship building skills with clinical and non-clinical personnel
  • Proven solid problem-solving skills

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.