Senior Physician Business Manager - Houston, TX

WellMed Network Operations Subject Matter Expert

Explore opportunities with WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will be part of a team who shares your passion for helping people achieve improved health outcomes. Join us and discover the meaning behind Caring. Connecting. Growing together.

This position functions as a subject matter expert in network operations. This position strives to bring consistency and experience to existing Physician Business Managers in the local market by analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. This position will organize and assist the local Physician Business Managers in achieving short and long term operational/strategic business goals/ by developing, enhancing and maintaining operational information and models. They also develop, in conjunction with the local Director/Manager, and implement effective/strategic business solutions through research and analysis of data and business processes.

General Profile:

• Analyzes risk pool and provider group performance to determine areas of focus or improvement opportunities
• Develops strategies to align contracted provider groups with company initiatives, goals (revenue and expense) and quality outcomes
• Create and develop action plans to achieve metrics in quality, coding and financial performance
• Provides explanations and interpretations within area of expertise
• Provides daily direction and guidance to existing local Physician Business Managers and acts as the subject matter expert for their assign area

Job Scope:

• Uses pertinent data and facts to identify and solve a range of problems through experience, research and collaboration
• Assists local Physician Business Managers with investigating non-standard requests and problems
• Prioritizes and organizes assigned workload of local Physician Business Managers is able to meet deadlines while delivering the best outcomes possible
• Provides explanations, direction and information to others on topics within area of expertise
• Collaborates with local Medical Director(s) to monitor utilization trends and profit pools to assist with developing strategic plans to improve performance

Primary Responsibilities:

• Solid analytical skills required to support, compile and report key information
• Drive processes and technology improvement initiatives that directly impact Revenue, HEDIS/STAR measures and Quality Metrics, using standard project methodology (requirements, design, test, etc.)
• Use data to identify trends, patterns and opportunities for the business and clients. Develop business strategies in line with company strategic initiatives
• Engage provider staff and providers in analysis and evaluation of functional models and process improvements; identify dependencies and priorities
• Evaluate and drive processes, provider relationships and implementation plans
• Produce, publish and distribute scheduled and ad-hoc client and operational reports relating to the development and performance of products
• Collaborate with other Physician Business Manager- Area Leads to foster teamwork and build consistency throughout the market
• Serves as a liaison to the health plan and all customers

Additional Job Information:

• Requires strong presentation skills, problem solving and ability to manage conflict and identify resolutions quickly
• Have the ability to communicate well with physicians, staff and internal departments

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:

• 5+ years of experience in a related medical field or health plan setting (network management, contracting and/or recruitment, or provider relations)
• Knowledge of Managed Care and Medicare programs
• Ability to develop long-term positive working relationships
• Ability to communicate and facilitate strategic meetings with groups of all sizes
• Solid business acumen, analytical, critical thinking and persuasion skills
• Exceptional interpersonal skills with ability to interface effectively internally with all levels of staff and externally with a wide range of people including physicians, office staff, hospital executives, medical groups, IPA's, the press and community organizations
• Solid verbal and written communication skills
• Proficiency in Microsoft Word, Excel and PowerPoint

Preferred Qualifications:

• Risk Adjustment knowledge related to CMS reimbursement models
• Ability to act as a mentor to others

Physical & Mental Requirements:

• Ability to lift up to 25 pounds
• Ability to push or pull heavy objects using up to 25 pounds of force
• Ability to sit for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

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 $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. 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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.