Provider Relations Advocate - Corpus Christi, TX
Optum, Corpus Christi, TX, United States
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.
Primary Responsibilities
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 in 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 market
Required Qualifications
High school diploma or equivalent experience
2+ years of provider relations or managed care experience
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
Intermediate level of proficiency with MS Suite (including Word, PowerPoint, and Excel)
Ability to work evenings and weekends on occasion based on business needs
Ability to travel as needed 50 - 75%
Driver's License and access to reliable transportation
Preferred Qualifications
Bachelor's degree in related field
LVN license
Experience presenting group presentations and training
Professional provider relations experience involving physicians and administrative staff
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
Established knowledge of local provider community
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 stand 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). The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
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Primary Responsibilities
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 in 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 market
Required Qualifications
High school diploma or equivalent experience
2+ years of provider relations or managed care experience
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
Intermediate level of proficiency with MS Suite (including Word, PowerPoint, and Excel)
Ability to work evenings and weekends on occasion based on business needs
Ability to travel as needed 50 - 75%
Driver's License and access to reliable transportation
Preferred Qualifications
Bachelor's degree in related field
LVN license
Experience presenting group presentations and training
Professional provider relations experience involving physicians and administrative staff
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
Established knowledge of local provider community
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 stand 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). The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
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