Requisition number: 2359637
Job category: Network Management
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
This position functions as a subject matter expert in Client Service operations. This position strives to bring consistency and experience to existing Client Services Account Managers in the local market by analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. This position will organize and assist assigned provider groups and/or financial pools, as well as fellow account managers, in achieving short and long term operational/strategic business goals/ by developing, enhancing and maintaining operational information and models. They also develop and implement, in conjunction with the local Client Services Associate Director and/or Director, effective/strategic business solutions through research and analysis of data and business processes. The Senior Account Manager will develop and sustain a strong day-to-day relationship with stakeholders, the providers, and office staff to effectively implement business solutions developed by the Optum leadership team. The Senior Account Manager is accountable for overall performance and profitability for their assigned provider groups and/or financial pools.
Schedule: FT, 40 hrs. Monday - Friday, 8am - 5pm EST
Location: This role is Remote in Ohio. Candidates must reside in OH (preferably in Cleveland metro area) and have the ability to be in the field approximately 50% of the time to meet with clients.
If you reside near OH , you'll enjoy the flexibility of a hybrid-remote position* as you take on some tough challenges.
Primary Responsibilities:
Analyze risk pool and/or provider group performance to determine areas of focus or improvement opportunities, to include performing analysis of financial statements and other metric-related report to determine areas of focus or improvement opportunities
Develops strategies and create action plans that align provider pools and groups with company initiatives, goals (revenue and expense) and quality outcomes
Drive processes and improvement initiatives that directly impact revenue, HEDIS/STAR measures and quality metrics, coding and documentation process and educational improvements
Use 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 issues
Collaborates with internal clinical services teams, alongside Client Services leaders, to monitor utilization trends and risk pools to assist with developing strategic plans to improve performance
Assists provider groups with investigating standard and non-standard requests and problems, to include claims and member support services
Maintains effective support services by working effectively with the Director of Client Services, Regional Medical Director, Clinical Services team, Operations and other corporate departments
Demonstrate understanding of providers' business goals and strategies in order to facilitate the analysis and resolution of their issues
Performs all other related duties as assigned
Strong analytical skills required to support, compile and report key information
Drive processes and technology improvement initiatives that directly impact Revenue, HEDIS/STAR measures and Quality Metrics, using standard project methodology (requirements, design, test, etc.)
Use data to identify trends, patterns and opportunities for the business and clients. Develop business strategies in line with company strategic initiatives
Engage provider staff and providers in analysis and evaluation of functional models and process improvements; identify dependencies and priorities
Evaluate and drive processes, provider relationships and implementation plans
Produce, publish and distribute scheduled and ad-hoc client and operational reports relating to the development and performance of products
Collaborate with other Client Services leads to foster teamwork and build consistency throughout the market
Serves as a liaison to the health plan and all customers
Requires strong presentation skills, problem solving and ability to manage conflict and identify resolutions quickly
Have the ability to communicate well with physicians, staff and internal departments
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending Account or a Health Saving account
Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Bachelor's Degree in Business Administration, Marketing, Healthcare Administration or a related field required OR 5+ years of experience in a related medical field or health plan setting (network management, contracting and/or recruitment, or provider relations)
2+ years of experience with Medicare health care operations including HEDIS, CMS reimbursement models, and Medicare Advantage
2+ years of experience working with state and federal laws relating to Medicare
Intermediate level Proficiency in Microsoft Word, Excel and PowerPoint
Ability and willingness to travel, both locally and non-locally, as determined by business need
Preferred Qualifications:
Master's Degree in Business Administration, Marketing, Healthcare Administration or a related field required
5+ years of experience in a healthcare related field
3+ years of healthcare management experience
Ability to act as a mentor to others
Soft Skills:
Ability to develop long-term positive working relationships
Ability to communicate and facilitate strategic meetings with groups of all sizes
Ability to work independently, use good judgment and decision-making process
Ability to conduct performance evaluation to identify performance measures or indicators and the actions needed to improve or correct performance, relative to the goals
Ability to resolve complete problems and evaluate options to implement solutions
Strong business acumen, analytical, critical thinking and persuasion skills
Exceptional interpersonal skills with ability to interface effectively internally with all levels of staff and externally with a wide range of people including physicians, office staff, hospital executives, medical groups, IPA's, the press and community organizations
Ability to adopt quickly to change in an ever-changing environment
Strong verbal and written communication skills are required
*All Telecommuters 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
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.
RPO #GREEN
