Caring. Connecting. Growing Together
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
The Account Manager has geographic responsibility for the quality and economic performance of the physician practice with the goal of developing a high performing provider network within the State of Kansas and Missouri. This includes analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. The Account Manager will develop and sustain a strong day-to-day relationship with stakeholders, the physician and office staff to effectively implement the business solutions developed by the Client Services leadership team.
The Account Manager is accountable for overall performance and profitability for their assigned groups as well as ownership and oversight to provide redirection as appropriate and approved. The responsibilities of this position include capabilities in the following areas : strategic planning and analysis; understanding of HEDIS, Star ratings, accurate documentation, and coding; advanced communication skills; and the ability to develop clear action plans and drive process.
If you are located in McPherson, KS, you will have the flexibility to work remotely
- as you take on some tough challenges.
Primary Responsibilities :
Solid analytical skills required to support, compile, and report key informationDrive processes that directly impact Revenue, HEDIS / STAR measures and Quality Metrics, and total cost of care, as appropriateUse data to identify trends, patterns and opportunities for the business and clients. Develop business strategies in line with company strategic initiativesEngage provider staff and providers in analysis and evaluation of functional models and process improvements; identify dependencies and prioritiesEvaluate and drive processes, provider relationships and implementation plansProduce, publish, and distribute scheduled and ad-hoc client and operational reports relating to the performance of related metrics and goalsCollaborate with internal leaders to foster teamwork and build consistency throughout the marketServes as a liaison to the health plan and all customersRequires solid presentation skills, problem solving and ability to manage conflict and identify resolutions quicklyHave the ability to communicate well with physicians, staff, and internal departmentsEssential Job Functions :
Educate providers to ensure they have the tools needed to meet quality, coding and documentation, and total medical cost goals per business development plansDevelops strategies and create action plans that align provider pools and groups with company initiatives, goals, quality outcomes, program incentives, and patient care best practicesDrive processes and improvement initiatives that directly impact revenue, HEDIS / STAR measures and quality metrics, coding and documentation process and educational improvementsConduct new provider orientations and ongoing education to provider and their staff on healthcare delivery products, health plan partnerships, processes, and toolsUse and analyze data to identify trends, patterns and opportunities for the business and clients, and collaborating and / or participating in discussions with colleagues and business partners to identify potential root cause of issuesConduct provider meetings to share and discuss reporting data and analysis, issue resolution needs, implement escalation processes for discrepancies, and manages or ensures appropriate scheduling, agenda, and materialsCollaborates with internal clinical services teams, alongside operational leaders' leaders, to monitor utilization trends to assist with developing strategic plans to improve performanceAssists provider groups with investigating standard and non-standard requests and problems, to include claims and member support servicesMaintains effective support services by collaborating effectively with the medical director, operations, and cross functional teams, and other departmentsDemonstrate understanding of providers' business goals and strategies to facilitate the analysis and resolution of their issuesPerforms all other related duties as assignedYou'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 :
3+ years of experience in a related medical field or health plan setting (network management, contracting and / or recruitment, or provider relations)Knowledge of state and federal laws relating to MedicareSolid working knowledge of Medicare health care operations including HEDIS, CMS reimbursement models, and Medicare AdvantageUnderstanding of IPAs, Clinically Integrated Networks, Medicare Shared Savings Programs, capitation / value-based contracting, and narrow networksProficiency in Microsoft Word, Excel, and PowerPointAbility to travel 25% of the timeDriver's License and access to a reliable transportationPreferred Qualifications :
Proven solid business acumen, analytical, critical thinking, and persuasion skillsDemonstrated ability to function as a mentor to othersDemonstrated ability to develop long-term positive working relationshipsDemonstrated ability to communicate and facilitate strategic meetings with groups of all sizesDemonstrated ability to work independently, use good judgment and decision-making processDemonstrated ability to conduct performance evaluation to identify performance measures or indicators and the actions needed to improve or correct performance, relative to the goalsDemonstrated ability to resolve complete problems and evaluate options to implement solutionsDemonstrated ability to adopt quickly to change in an ever-changing environmentAll employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.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). The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.