Physician Business Manager
UnitedHealth Group
- Laredo, TX
- Permanent
- Full-time
- 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
- 3+ years of provider relations or managed care experience
- Solid knowledge of local provider community
- Proven 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
- Proven excellent analytical and problem-solving skills with effective follow through
- Proven solid verbal and written communication skills
- Professional provider relations experience involving physicians and administrative staff
- Provider recruitment and contracting experience
- Proven presentation skills to small and large groups