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Physician Business Manager, WellMed - El Paso, TX or Las Cruces, NM
at UnitedHealth Group
The Physician Business Manager 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 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 strong working relationships with cross-functional departments, vendors, local sales, 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 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
- Work at the direction of their assigned leader to recruit / contract providers ensuring network adequacy
- 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
- Provider support to maintain and develop ongoing value related to the WellMed Value Proposition
- Introduce and advocate company resources to facilitate practice optimization
- Identify at risk situations and develop a plan for escalation and corrective action
- High school diploma or equivalent work experience
- 2 years of provider network experience such as provider relations, contracting, credentialing, etc.
- Experience with claims processing and issue resolution
- Experience with Medicare and Medicaid regulations, as well as Medicare Advantage plans
- At least an intermediate level of proficiency with MS Word, Excel, PowerPoint and Outlook
- Must have access to reliable transportation and ability to travel up to 70% within southern New Mexico/western El Paso area (including, but not limited to: El Paso, Otero, Dona Ana, Hidalgo, Luna, Grant and Sierra counties)
- Flexibility to working outside regular business hours (evenings/weekends) as needs require
- Undergraduate degree
- Bilingual proficiency in Spanish/English
- Exceptional presentation, written and verbal communication skills
- Ability to work independently and remain on task
- Good organization and planning skills
- Ability to prioritize and meet deadlines from multi-staff members within the department
Careers 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 240,000 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: health care, healthcare, managed care, provider relations, provider advocate, physician, network, network management, membership, Medicare, Medicaid, WellMed, El Paso, TX, Texas, Las Cruces, NM, New Mexico