Talent.com
Practice Performance Manager - Medicare Consultant - Overland Park, Kansas
Practice Performance Manager - Medicare Consultant - Overland Park, KansasUnitedHealth Group • Overland Park, KS, US
Practice Performance Manager - Medicare Consultant - Overland Park, Kansas

Practice Performance Manager - Medicare Consultant - Overland Park, Kansas

UnitedHealth Group • Overland Park, KS, US
2 days ago
Job type
  • Full-time
Job description

Practice Performance Manager - Medicare Consultant

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Practice Performance Manager - Medicare Consultant is responsible for program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy demonstrating full assessment and suspect closure. The person in this role is expected to 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. The person will review charts (paper and electronic - EMR), identify gaps in care and open suspect opportunities, and educate providers and offices to ensure they are coding to the highest specificity for both risk adjustment and quality reporting. Work is primarily performed at physician practices on a daily basis.

If you are located in Kansas, you will have the flexibility to work remotely

  • as you take on some tough challenges

Primary Responsibilities :

  • Functioning independently, travel across assigned territory to meet with providers to discuss UHC and Optum tools and UHC incentive programs for both risk adjustment and quality reporting, focused on improving the quality of care for Medicare Advantage Members
  • Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
  • Develop comprehensive, provider-specific plans to increase their HEDIS performance, facilitate risk adjustment suspect closure and improve their outcomes
  • Access PCOR to identify risk adjustment opportunities and utilize other available reporting sources including but not limited to (InSite, Spotlight, Doc360, Provider Scorecard, CPT II Report) to analyze data and prioritize gap and suspect closure, identify trends and drive educational opportunities
  • Conduct chart review quarterly and provide timely feedback to provider to improve reporting on a go forward basis.
  • Conduct additional chart reviews such as a quarterly post-visit ACV review and various focused progress notes reviews with provider feedback to improve documentation and coding resulting in improved gap and suspect closure.
  • Coordinates and provides ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution.
  • Training will include Stars measures (HEDIS / CAHPS / HOS / medication adherence), coding for quality care (CPT II) and exclusions (ICD-10-CM), risk adjustment coding practices (ICD-10-CM), and Optum program administration including use of plan tools, reports and systems
  • Lead regular Stars and risk adjustment specific JOC meetings with provider groups to drive continual process improvement and achieve goals
  • Provide reporting to health plan leadership on progress of overall performance, MAPCPi, MCAIP, gap closure, and use of virtual administrative resources
  • Facilitate / lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
  • Collaborates and communicates with the members health care and service with our interdisciplinary delivery team to coordinate the care needs for the member
  • Partner with providers to engage in UnitedHealthcare member programs such as HouseCalls, clinic days, Navigate4Me
  • Weekly commitment of 80% travel for business meetings (including client / health plan partners and provider meetings) and 20% remote work
  • 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 :

  • Certified Risk Adjustment Coder (CRC via AAPC) or either : Certified Professional Coder (CPC via AAPC) or Certified Coding Specialist - Physician-based (CCS-P via AHIMA) with the requirement to obtain both certifications within first year in position (CRC within 6 months of hire and CPC within 1 year of hire, if not currently CPC or CCS-P)
  • 5+ years of healthcare industry experience
  • 1+ years of provider facing experience
  • 1+ years of Account Management or Sales Account experience
  • Proven knowledge of ICD-10-CM and CPT II coding
  • Proven solid knowledge of Medicare Advantage including Stars and Risk Adjustment
  • Proven solid relationship building skills with clinical and non-clinical personnel
  • Proven excellent oral & written communication skills
  • Microsoft Office experience including Excel with exceptional analytical and data representation expertise
  • Weekly commitment of 80% travel for business meetings (including client / health plan partners and provider meetings) and 20% remote work
  • Driver's License and access to reliable transportation
  • Reside in Kansas
  • Preferred Qualifications :

  • Registered Nurse
  • Solid communication and presentation skills
  • Solid problem-solving skills
  • Experience working for a health plan and / or within a provider office
  • Knowledge base of clinical standards of care, preventive health, and Stars measures
  • Experience with network and provider relations / contracting
  • Experience retrieving data from EMRs (electronic medical records)
  • Demonstrate a level of knowledge, skill and understanding of ICD-10-CM and CPT coding principles consistent with certification by AAPC or AHIMA
  • Experience in management or coding position in a provider primary care practice
  • Knowledge of billing or claims submission and other related actions
  • Good work ethic, desire to succeed, self-starter
  • Ability to deliver training materials designed to improve provider compliance
  • Ability to use independent judgment, and to manage and impart confidential information
  • Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

    Create a job alert for this search

    Performance Manager • Overland Park, KS, US

    Related jobs
    Geriatric Medicine Fellowship Program Director in Florida

    Geriatric Medicine Fellowship Program Director in Florida

    Cleveland Clinic • Weston, US
    Full-time
    Cleveland Clinic Florida’s Primary Care Institute.Program Director for the Geriatric Medicine Fellowship Program.This ACGME-accredited, one-year fellowship has been training future leaders in Geria...Show more
    Last updated: 30+ days ago • Promoted
    Travel Nurse RN - ED - Emergency Department - $2,072 per week

    Travel Nurse RN - ED - Emergency Department - $2,072 per week

    HealthTrust Workforce Solutions HCA • Belton, MO, United States
    Full-time
    HealthTrust Workforce Solutions HCA is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Belton, Missouri. Job Description & Requirements.Required : ACLS, BLS, PALS, TNC...Show more
    Last updated: 30+ days ago • Promoted
    Licensed Addictions Counselor (SB123)

    Licensed Addictions Counselor (SB123)

    The Guidance Center • Leavenworth, KS, United States
    Full-time
    The Guidance Center (TGC) is the Community Mental Health Center and Certified Behavioral Health Clinic serving Leavenworth, Atchison, and Jefferson counties in Kansas. We provide high-quality care t...Show more
    Last updated: 30+ days ago • Promoted
    Family Practice Physician

    Family Practice Physician

    United States Army • Basehor, KS, US
    Permanent
    THE STRENGTH TO HEAL OUR NATION'S DEFENDERS.You could make a difference as you work in an environment dedicated to helping our Soldiers and their families. As a family physician and officer on the U...Show more
    Last updated: 1 day ago • Promoted
    Lead Medical Director

    Lead Medical Director

    Blue Cross and Blue Shield of Kansas City • Kansas City, MO, United States
    Full-time
    Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include : .Highly com...Show more
    Last updated: 30+ days ago • Promoted
    Consulting Actuary - Medicare Risk Adjustment

    Consulting Actuary - Medicare Risk Adjustment

    Blue Cross and Blue Shield of North Carolina • Kansas City, MO, United States
    Full-time
    As a Consulting Actuary at our healthcare organization, you will play a pivotal role in shaping the future of care delivery through data-driven insights and strategic actuarial expertise.You'll lea...Show more
    Last updated: 30+ days ago • Promoted
    Join Our Team : Pulmonary Critical Care Physicians

    Join Our Team : Pulmonary Critical Care Physicians

    Cleveland Clinic • Weston, US
    Full-time
    Cleveland Clinic Florida’s Integrated Hospital Care Institute.Department of Pulmonary Critical Care is seeking a combination of outpatient pulmonary medicine as well as inpatient pulmonary and crit...Show more
    Last updated: 30+ days ago • Promoted
    Mobile Crisis Response Clinician - PRN

    Mobile Crisis Response Clinician - PRN

    The Guidance Center • Leavenworth, KS, United States
    Full-time
    The Guidance Center (TGC) is the Community Mental Health Center and Certified Behavioral Health Clinic serving Leavenworth, Atchison, and Jefferson counties in Kansas. We provide high-quality care t...Show more
    Last updated: 30+ days ago • Promoted
    Practice Manager II

    Practice Manager II

    Saint Luke's Health System • Kansas City, MO, US
    Full-time
    The Practice Manager assumes accountability for the overall planning, coordination, and delivery of services.Working collaboratively with physician operations leadership, assumes a leadership role ...Show more
    Last updated: 3 days ago • Promoted
    Per Diem / PRN Nurse RN - ED - Emergency Department - $53 per hour

    Per Diem / PRN Nurse RN - ED - Emergency Department - $53 per hour

    HealthTrust Workforce Solutions Local • Belton, MO, United States
    Full-time
    HealthTrust Workforce Solutions Local is seeking a per diem / prn nurse RN ED - Emergency Department for a per diem / prn nursing job in Belton, Missouri. Job Description & Requirements.Entrust Your...Show more
    Last updated: 19 days ago • Promoted
    Medical Director

    Medical Director

    Blue Cross and Blue Shield of Kansas City • Kansas City, MO, United States
    Full-time
    Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include : .Highly com...Show more
    Last updated: 30+ days ago • Promoted
    Crisis Case Manager - PT

    Crisis Case Manager - PT

    The Guidance Center • Leavenworth, KS, United States
    Full-time
    The Guidance Center (TGC) is the Community Mental Health Center and Certified Behavioral Health Clinic serving Leavenworth, Atchison, and Jefferson counties in Kansas. We provide high-quality care t...Show more
    Last updated: 30+ days ago • Promoted
    Local Contract Nurse RN - ED - Emergency Department - $52-56 per hour

    Local Contract Nurse RN - ED - Emergency Department - $52-56 per hour

    HealthTrust Workforce Solutions Local • Belton, MO, United States
    Full-time
    HealthTrust Workforce Solutions Local is seeking a local contract nurse RN ED - Emergency Department for a local contract nursing job in Belton, Missouri. Job Description & Requirements.Minimum of m...Show more
    Last updated: 12 days ago • Promoted
    Senior Field Reimbursement Manager - South Central

    Senior Field Reimbursement Manager - South Central

    Fresenius Kabi USA, LLC • Kansas City, MO, United States
    Full-time
    The Senior Field Reimbursement Manager (FRM) plays a vital role in helping patients gain access to life changing therapies. From oral medications to biosimilars to critical cancer treatments.Freseni...Show more
    Last updated: 13 days ago • Promoted
    Clinical Director

    Clinical Director

    EPIC Surgery Center (10307) • LEAWOOD, Kansas, United States
    Full-time
    Clinical Director to join our team.Epic Surgery Center is a fast paced ASC environment committed to producing the highest quality work and experience for patients and their families.The Ambulatory ...Show more
    Last updated: 7 days ago • Promoted
    Licensed Clinical Professional Counselor (LCPC) (LSCSW) - Belton, MO

    Licensed Clinical Professional Counselor (LCPC) (LSCSW) - Belton, MO

    LifeStance Health • Belton, MO, US
    Full-time
    At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make lives better. Our mission is to help people lead healthier, more fulfilling lives...Show more
    Last updated: 14 hours ago • Promoted • New!
    Crisis Case Manager - PRN

    Crisis Case Manager - PRN

    The Guidance Center • Leavenworth, KS, United States
    Full-time
    The Guidance Center (TGC) is the Community Mental Health Center and Certified Behavioral Health Clinic serving Leavenworth, Atchison, and Jefferson counties in Kansas. We provide high-quality care t...Show more
    Last updated: 30+ days ago • Promoted
    Mobile Crisis Case Manager (MCCM) - PT Weekends

    Mobile Crisis Case Manager (MCCM) - PT Weekends

    The Guidance Center • Leavenworth, KS, United States
    Full-time
    The Guidance Center (TGC) is the Community Mental Health Center and Certified Behavioral Health Clinic serving Leavenworth, Atchison, and Jefferson counties in Kansas. We provide high-quality care t...Show more
    Last updated: 30+ days ago • Promoted