Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.
The Physician Business Manager with WellMed is responsible for developing, maintaining, and servicing a high quality, marketable, and satisfied provider network within an assigned geographic area. 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 build and sustain solid working relationships with cross functional departments, vendors, local network, 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.
- Educate providers to ensure that they have the tools they need to meet quality, risk adjustment, growth (as appropriate), and total medical cost goals per business development plans
- Ensure 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
- Conduct detailed analysis of various reports by tracking and trending data to develop a strategic plan to ensure performance goals are achieved
- Ensure the overall strategic plan incorporates interventions with internal departments or subject matter experts, external vendors, and others, as needed
- Participate in creation and execution of a local network development plan to assure network adequacy as needed
- Conduct new provider orientations and ongoing education to providers and their staffs on healthcare delivery products, health plan partnerships, processes, and compensation arrangements
- Maintain 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
- Conduct provider meetings to share and discuss economic data, troubleshoot for issue resolution, and implement an escalation process for discrepancies
- Collaborate with provider groups to develop, execute, and monitor performance and patient outcomes improvement plans
- Collaborate with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs
- Handle or ensure appropriate scheduling, agenda, materials, location, meals, and minutes of provider meetings as needed
- Collaborate with contracting team to ensure provider data is correct and provider directories include any needed updates
- Complete Practitioner Data Forms and Provider Change Forms as needed
- Represent WellMed/UHG by holding company sponsored provider events (summits, learning sessions)
- Provide information and participate in management meetings as requested
- Regularly meet with cross functional team to create, revise, and adjust strategy for assigned provider groups to meet overall performance goals
- Provide support to maintain and develop ongoing value related to the WellMed Value Proposition
- Introduce and advocate company resources to facilitate practice optimization
- Ability to travel as needed 50 - 75% within Corpus Christi, TX market
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.
- High school diploma or equivalent experience
- 2+ years of provider relations or managed care experience
- Intermediate level of proficiency with MS Suite (including Word, PowerPoint, and Excel)
- Proven 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
- Ability to work evenings and weekends on occasion based on business needs
- Ability to travel as needed 50 - 75% in the Corpus Christi, TX market
- Bachelor's degree in related field
- Experience presenting group presentations and training
- Professional provider relations experience involving physicians and administrative staff
- Established knowledge of local provider community
- Significant understanding of medical care financing and delivery systems, provider contracting, reimbursement arrangements and network management
- Understanding of medical care financing and delivery systems, provider contracting, reimbursement arrangements, and network management
- Proven excellent analytical and problem-solving skills with effective follow through
Physical & Mental Requirements:
- Ability to lift up to 25 pounds
- 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
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. 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.
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.