Senior Physician Business Manager/ Senior Project Lead - Port St. Lucie, FL
The Physician Business Manager is responsible for developing, maintaining and servicing a high quality, marketable and satisfied provider network within an assigned geographic area. Key responsibilities include may include recruitment and contracting, education and servicing of assigned providers. The Physician Business Manager helps assigned Providers operate successfully within our healthcare delivery model by providing strategic planning and tools to meet goals. This position is expected to maintain strong working relationships with cross functional departments, vendors, local sales, and assigned Providers. The Physician Business Manager is accountable for overall performance and profitability for their assigned groups as well as ownership and oversight to provide redirection as appropriate.
Primary
Responsibilities:
Ensures Providers 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
Completes detailed analysis of various reports by tracking and trending data to develop a strategic plan to ensure performance goals are achieved
Responsible for managing a variety of projects and deliverables related to Quality (HEDIS/STAR), Risk Adjustment, Population Health Management, Contracting, Provider Education and other projects as assigned. The position will provide a wide variety of support functions to Market Operations and other areas as assigned to ensure enterprise and market operational goals are met consistently
Assists with training; including the documentation of department workflows and developing market training approach
Work with applicable department team members in the implementation of programs or projects, including planning, developing, implementing and evaluating programs and projects, coordinating project activities, collaborating with project team members, and monitoring progress toward achievement for Market Operations and other projects as assigned
Facilitates meetings as necessary, contributes to planning and decision making, coordinates project resources and collaborates with project stakeholders to collect and disseminate project information
Facilitates communication and timely follow up with team members and other appropriate parties
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
Works closely 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
Provides information and participate in management meetings as requested
Regularly meets with cross functional team to create, revise and adjust strategic 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 WellMed Resources as needed to facilitate practice optimization
Identifies at risk situations and develops a plan for escalation and corrective action
Performs all other related duties as assigned
Required
Qualifications:
Associate's degree in related field required or a minimum of 4 years of comparable work experience beyond the required years of experience may be substituted in lieu of a Associate's degree
3 years of provider relations or managed care experience
Some experience with Project Management and working with multiple projects
Solid knowledge of local provider community
Preferred
Qualifications:
Bachelor's Degree with a significant understanding of medical care financing and delivery systems, provider contracting, reimbursement arrangements and network management
Presentation skills to small and large groups
Professional provider relations experience involving physicians and administrative staff
Provider recruitment and contracting experience
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
Excellent analytical and problem solving skills with effective follow through
Strong verbal and written communication skills
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000 lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
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.
Job Keywords: physician business manager, project management, provider relations, management, Port St. Lucie, FL, Florida
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications.
Primary
Responsibilities:
Ensures Providers 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
Completes detailed analysis of various reports by tracking and trending data to develop a strategic plan to ensure performance goals are achieved
Responsible for managing a variety of projects and deliverables related to Quality (HEDIS/STAR), Risk Adjustment, Population Health Management, Contracting, Provider Education and other projects as assigned. The position will provide a wide variety of support functions to Market Operations and other areas as assigned to ensure enterprise and market operational goals are met consistently
Assists with training; including the documentation of department workflows and developing market training approach
Work with applicable department team members in the implementation of programs or projects, including planning, developing, implementing and evaluating programs and projects, coordinating project activities, collaborating with project team members, and monitoring progress toward achievement for Market Operations and other projects as assigned
Facilitates meetings as necessary, contributes to planning and decision making, coordinates project resources and collaborates with project stakeholders to collect and disseminate project information
Facilitates communication and timely follow up with team members and other appropriate parties
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
Works closely 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
Provides information and participate in management meetings as requested
Regularly meets with cross functional team to create, revise and adjust strategic 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 WellMed Resources as needed to facilitate practice optimization
Identifies at risk situations and develops a plan for escalation and corrective action
Performs all other related duties as assigned
Required
Qualifications:
Associate's degree in related field required or a minimum of 4 years of comparable work experience beyond the required years of experience may be substituted in lieu of a Associate's degree
3 years of provider relations or managed care experience
Some experience with Project Management and working with multiple projects
Solid knowledge of local provider community
Preferred
Qualifications:
Bachelor's Degree with a significant understanding of medical care financing and delivery systems, provider contracting, reimbursement arrangements and network management
Presentation skills to small and large groups
Professional provider relations experience involving physicians and administrative staff
Provider recruitment and contracting experience
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
Excellent analytical and problem solving skills with effective follow through
Strong verbal and written communication skills
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000 lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
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.
Job Keywords: physician business manager, project management, provider relations, management, Port St. Lucie, FL, Florida
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications.
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