UnitedHealth Group Hiring For Provider Relations Consultant at Lakewood, NJ  / Toms River, NJ  Full Time

Riverside Medical Group is the premier medical practice in New Jersey serving patients in Hudson, Bergen, Passaic, Essex, Middlesex, Burlington, and Camden counties. We have over 60 locations and 180 board certified medical providers specializing in Adult Medicine, Pediatrics, ENT, Foot & Ankle, Gastroenterology, Rheumatology, Cardiology, Behavioral Health, Physical Therapy, Allergy & Immunology, Developmental Health, Pain Management, Chiropractic and Optometry.

As a National Committee for Quality Assurance “Level III- Patient Centered Medical Home,” Riverside is able to provide patient-focused precision medical care to the entire family and is committed to providing patients with the highest quality medical care.

In addition to providing the highest quality of care, Riverside offers its patients the best hours of operation of any private practice in the country. Patients have around-the-clock access to a health-care team and have the benefit of same day and walk in appointments. As an advocate for prenatal health and education, Riverside offers prenatal classes every weekend free of charge. Riverside believes in giving back to their community and the patients they serve through health fairs, charitable giving/foundation, and free medical education.

As a part of the OptumCare network, Riverside Medical Group is seeking an Associate Practice Performance Manager to join our growing team in New Jersey. At Optum, we are transforming healthcare nationally while providing physician-led care locally. Work with the largest care delivery organization in the world and start doing your life’s best work.(sm)

We are hiring an Associate Practice Performance Manager to join our team in Toms River, NJ. The Associate Practice Performance Manager is responsible for program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy.  The person in this role is expected to work directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results. The person will review charts (paper and electronic – EMR), look for gaps in care, perform telephonic assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention. Work is primarily performed at physician practices on a daily basis.

Primary Responsibilities:

• Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members
• Execute applicable provider incentive programs for health plan
• Assist in the review of medical records to highlight Star opportunities for the medical staff
• Activities include data collection, data entry, quality monitoring, upload of images, and chart collection activities
• Locate medical screening results/documentation to ensure quality measures are followed in the closure of gaps. Will not conduct any evaluation or interpretation of Clinical data and will be supervised by licensed and/or certified staff
• Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
• Develop comprehensive, provider-specific plans to increase their HEDIS performance and improve their outcomes
• Provide ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
• Act as lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation.  Training will include Stars measures (HEDIS/CAHPS/HOS/med adherence), and Optum program administration, use of plan tools, reports and systems
• Coordinate and lead Stars-specific JOC meetings with provider groups with regular frequency to drive continual process improvement and achieve goals
• Provide reporting to health plan leadership on progress of overall performance, gap closure, and use of virtual administrative resource
• Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
• Provide suggestions and feedback to Optum and health plan
• Work collaboratively with health plan market leads to make providers aware of Plan-sponsored initiatives designed to assist and empower members in closing gaps
• Includes up to 30% remote work and 70% local travel to Physician and Provider offices
• Other duties, as assigned

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.

Qualifications – External

Required Qualifications:

• 1+ years of clinical or work experience for a health plan and/or for a provider’s office 
• Experience with communication and presentation skills
• Experience building relationships with clinical and non-clinical personnel
• Microsoft Office specialist with exceptional analytical/data representation expertise; Advanced Excel, Outlook & PowerPoint skills
• Ability to travel up to 70% to local Physician /Provider offices in Ocean county, NJ with 30% remote work
• Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance. 

Preferred Qualifications:

• CRC/CPC certification or actual experience with risk adjustment coding
• Bachelor’s Degree or equivalent work experience
• 3+ years of healthcare industry experience
• 1+ years of STARs experience
• Medical/clinical background
• Solid knowledge of electronic medical record systems
• Consulting experience
• Solid knowledge of the Medicare market
• Knowledge base of clinical standards of care, preventive health, and Stars measures
• Experience in managed care working with network and provider relations/contracting
• Solid problem-solving skills
• Solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)

Opportunities with Riverside Medical Group. Discover what it means to be part of a top-rated, premier medical practice with a deep commitment to serving its community for over 35 years. We’re also part of the best hospital system in New Jersey and one of the best 50 hospitals in the nation. Riverside Medical Group has over 25 locations in Northern New Jersey, and we deliver quality-focused care to patients of all ages. We recently became part of OptumCare – the health care delivery part of Optum, backed by the scale and resources of the UnitedHealth Group family of companies. Every day we provide the ultimate patient experience through round-the-clock access to health care teams, same day and walk-in appointments, as well as charitable giving and a foundation that supports scholarships and medical research. At Riverside, you’ll play an important role in helping people achieve optimal health, and that’s just the start. Learn more about career opportunities with Riverside Medical Group, where you can help change the world as you do your life’s best work.(sm)