Location: Nashville,TN, USA
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 Practice Management Specialist must demonstrate strong clinical and analytic skills, strong oral and written communication skills and must be comfortable working closely with senior leaders at high volume facilities/groups and/or providers. The Practice Specialist will be responsible for the development of relationships with, groups, facilities as well as other outpatient behavioral health providers. The Practice Specialist will monitor their clinical effectiveness and efficiency, as well as compliance with contractual obligations. This Specialist will work closely with Clinical Operations, Provider Relations and Contracting, Legal, and Program and Network Integrity teams to affect desired outcomes with facilities/programs/providers as it relates to treatment for our membership.
The Specialist will partner with facilities/groups/providers in the following manner: Those facilities and/or providers/groups that operate outside of typical practice or billing patterns will be subject to a specific set of interventions. The Practice Specialist's role with these facilities/groups/providers will be to coordinate a strategic effort that includes Clinical Operations, Provider Relations and Contracting, Legal, and Program and Network Integrity with the goal of designing and delivering interventions aimed at improving clinical performance and outcomes.
If you are located in Tennessee, you will have the flexibility to work remotely* as you take on some tough challenges.
**Primary Responsibilities:**
+ Interface with senior leaders (e.g., CEO) at high volume facilities/groups or directly with providers as indicated
+ Communicate with facilities/groups/providers to initiate appropriate interventions focused on improvement of clinical outcomes and efficiency, as well as compliance with clinical processes and contractual obligations
+ Support those high performing facilities and providers such that performance remains at a high level
+ Identify outliers through analysis of clinical outcomes data, utilization/claims data, complaints, and compliance with care advocacy protocols
+ Measure improvement of program/provider performance over time
+ Monitor and report effectiveness of interventions
+ Modify interventions as appropriate
+ Initiate and monitor Performance Improvement Plans (PIPs) as appropriate to affect performance as the result of audit activity
+ Interface with other Optum departments including Clinical Operations, Provider Relations and Contracting, Legal, and Program and Network Integrity as appropriate
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:**
+ Licensed Master's degree-level clinician in Psychology, Social Work, Counseling or Marriage or Family Counseling, Licensed Ph.D. level Psychologist, or Registered Nurse (Licenses must be independent, active and unrestricted)
+ 3+ years of Managed Care and/or Utilization Review experience in a Managed Care setting
+ Solid knowledge of CPT/HCPCS codes
+ Proven solid analytical skills with knowledge of or willingness to learn analytics software such as Microsoft Excel
+ Proven solid communication skills, written and verbal
+ Solid computer skills at the intermediate level, proficiency with MS Office
+ Proven ability to balance contractual and clinical considerations
+ Demonstrated excellent time management and prioritization skills
+ Proven ability to establish and maintain strategic relationships with leadership teams
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
_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: 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_
_#RPO_