The Provider Relations Advocate is responsible for developing, maintaining and servicing a high quality, marketable and satisfied provider network within an assigned geographic area. Key responsibilities include recruitment and contracting, education and servicing of assigned providers. The Provider Relations Advocate 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 strong working relationships with cross functional departments, vendors, local sales, and assigned Providers. The Provider Relations Advocate 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 they have the tools they need to meet Quality, Risk adjustment, growth (as appropriate) and Total Medical Cost goals per business development plans Ensures 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 Ensures the overall strategic plan incorporates interventions with internal departments or subject matter experts, external vendors, and others as needed Participates in creation and execution of a local network development plan to assure network adequacy as needed Works at the direction of their assigned leader to recruit/contract providers ensuring network adequacy Conducts new provider orientations and ongoing education to providers and their staffs on healthcare delivery products, health plan partnerships, processes and compensation arrangements Maintains 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 Conducts provider meetings to share and discuss economic data, troubleshoots for issue resolution, and implements an escalation process for discrepancies Collaborates with provider groups to develop, execute and monitor performance and patient outcomes improvement plans Collaborates with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs Handles or ensures appropriate scheduling, agenda, materials, location, meals and minutes of provider meetings as needed Collaborates with contracting team to ensure provider data is correct and Provider directories include any needed updates. Completes Practitioner Data Forms and Provider Change Forms as needed Represent WellMed/UHG by holding company sponsored Provider events (Summits, Learning Sessions) Provides information and participate in management meetings as requested Regularly meets with cross functional team to create, revise and adjust strategy for assigned Provider Groups to meet overall performance goals Provider support to maintain and develop ongoing value related to the WellMed Value Proposition Introduce and advocate company resources to facilitate practice optimization Identifies at risk situations and develops a plan for escalation and corrective action
Required Qualifications:High school diploma or equivalent, or related experience 3+ years of provider relations or managed care experience 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 Demonstrated experience with making presentations to both small and large groups Access to reliable transportation and ability to travel up to 75% within greater Dallas/Fort Worth area Ability to work evenings and weekends on occasion based on business needs At least an intermediate proficiency with MS Suite (including Word, PowerPoint and Excel) Preferred Qualifications:Advanced degree Understanding of medical care financing and delivery systems, provider contracting, reimbursement arrangements and network management Established knowledge of local provider community Excellent analytical and problem solving skills with effective follow throughCareers 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 90,000+ 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) 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. Job Keywords: Provider Relations, provider network, provider education, quality, risk adjustment, network development, WellMed, travel, Dallas, Fort Worth, DFW, Texas, TX
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.