Manager of Provider Relations - Dallas, TX

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)The purpose of this position is to support the physician business management team through participation in design, development and tactical implementation of strategic business objectives for successful retention, management and growth of the WellMed contracted primary care, specialty care and ancillary provider network. These initiatives should result in the contracted network being able to understand and support the vision to change the face of healthcare delivery for seniors. This will drive the financial viability of the market and provide a full continuum of care for the members. The responsibilities of this position demand a wide range of capabilities including: strategic planning and analysis skills; strong understanding of billing and collections for physicians and or medical practices; accounting knowledge and understanding of financial statements; understanding of managed care contracts; understanding of HEDIS and HCC coding; management breadth to direct and motivate; highly developed communication skills; and the ability to develop clear action plans and drive process, given often ambiguous issues with numerous interdependencies. This position will facilitate any unresolved issues that remain as a result from following the standard process.Primary Responsibilities:Manages Physician Business Managers’ staff and for the overall success of the market’s network of contracted physiciansAll aspects of staff development to include hiring, training, coaching and developmentMaximizes staff performance and technical expertise through clearly defined objectives, training, skill development and leadership to ensure quality services to all customersDelegate, monitor and control work progress on key metrics, initiatives / action plans, staff productivity, and administrative expensesParticipates in development and implementation of systems that support network operations and network managementMaintains effective network support services by working effectively with the Medical Director, Market Medical Director, Regional Team, Clinic Operations and other corporate departmentsHandles complex and/or difficult provider inquires and/or problems and facilitates resolution of provider issues. Continuously strive to ensure that favorable relationships are maintained while ensuring the interest of the organizationTakes ownership of total work process and provides constructive information to ensure physician partners have support to meet initiativesAnalyzes data while collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issuesDemonstrate understanding of providers' business goals and strategies in order to facilitate the analysis and resolution of their issuesWork with relevant internal stakeholders to identify obstacles and barriers identified by providers, and methods for removing themCommunicate and advocate providers' needs to internal stakeholders in order to drive creation of solutions that meet our mutual business goalsCommunicate industry and company information to providers through various means (e.g., newsletters; emails; outreach calls; teleconference; conferences; on-site meetings)Develops and coaches staff to facilitate strategic business meetings with physician groups and their staffAssists with and manages business projections, forecasting and budgets, both financially and with timelines, for assigned projectsGuides, oversees and ensures competency of the Physician Business Manager staffAssist corporate education team and provides input on tools used to education Physician Business Manager staffEnsures all education objectives are being met, both on a formal and ad-hoc basis.Ensuring the Physician Business Manager staff is responding to provider inquiries andResolving provider issues on a daily basis. Facilitates provider discussions and assists in negotiating resolution to escalated provider issues with the capability to determine if/when issues require escalationCollectively works with Care Management leadership to create, maintain, implement and evaluate business strategic plans that positively impact total medical costsWorks closely with Corporate Sales & Marketing, Quality Practice Support Unit, DataRAPS and Quality departments to attain metric targets by collaboratively creating, maintaining, implementing and evaluating business strategic plans for each areaSelection of additions to the primary care network. This includes creation of strategic plan, training of the Physician Business Managers to carry out the strategic plan, negotiation of the contract as well as overall implementation of new primary care provider groupsUnderstands payer relationships within market and ensures any operational issues are visible to the appropriate parties and ensures issue resolutionPerforms all other related duties as assignedThe information listed above is not comprehensive of all duties / responsibilities performed.This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.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 (4+ years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)5+ years of related experience in network development/provider relations3+ years with management and/or supervisory experienceSolid working knowledge of Medicare health care operations including HEDIS, HCC Coding and Medicare AdvantageKnowledge of state and federal laws relating to MedicareReliable transportation and ability and willingness to travel throughout the area regularlyThis is a combination of a field base, office base and work from home position for the for the Dallas and North Texas areaIf you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking ordersPreferred Qualifications:Master’s degree5+ years of experience in a healthcare related field3+ years of Healthcare management experienceCareers 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 550,000+ 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)WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.For more information on our Internal Job Posting Policy, click here.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.Job Keywords: Manager, Physician Business Management, Physician relations, provider relations advocate, HEDIS and HCC coding, Medicare Advantage, Dallas, TX, TexasBrand: Optum Care DeliveryJob ID: 933486Employment Type: Full-timeJob Area: Health Care Operations