Coding Compliance Manager Remote Jobs in Hawaii (NOW HIRING)

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The 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.

Positions in this function drive clinical relationships and engagement with physician practices, members, and pharmacies while partnering internally (with areas such as Network contract ACO mgrs, Health Care Economics and Analytics, Medical Directors, Reporting, Health Plan market leaders) with a goal of improving health, well-being, quality and practice performance while reducing medical costs. Positions are accountable for the full range of clinical practice performance which may include but is not limited to improvement on HEDIS and STARs gap closure, coding accuracy, facilitating effective education and reporting, effective super utilizer engagement (e.g., members with complex and/or chronic conditions), and proactively identifying performance improvement opportunities through the use of data analytics, technology, workflow changes and clinical support. These roles develop comprehensive, provider-specific plans to increase their physician practice performance, reduce readmissions and improve their outcomes. Generally work is self-directed and not prescribed.

If you are located in Hawaii, you will have the flexibility to work remotely*, as well as work in the office as you take on some tough challenges.

Primary Responsibilities:

• Functioning independently, travel across assigned territory to meet with providers to discuss UHG tools and programs focused on improving the quality of care for Medicare Advantage Members
• Execute applicable provider incentive programs for health plan
• 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
• Participate within department campaigns to improve overall quality improvements within measure star ratings or contracts
• Work internally with leadership on adhoc projects, initiatives, and sprints to address measure star ratings and increase overall measure performance
• Create strategy and action plans for targeted provider groups to increase healthcare delivery, star ratings, and maximize on gap closures
• Weekly commitment of 60% travel for business meetings (including client/health plan partners and provider meetings) and 40% remote work
• Works with less structured, more complex issues
• Serves as a resource to others

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:

• 5 years of healthcare industry experience
• 3 years of experience working for a health plan and/or for a provider's office
• 1 year of STARs experience
• Proven solid communication and presentation skills
• Proven solid relationship building skills with clinical and non-clinical personnel
• Weekly commitment of 60% travel for business meetings (including client/health plan partners and provider meetings) and 40% remote work

Preferred Qualifications:

• Consulting experience
• Experience in managed care working with network and provider relations/contracting
• Solid knowledge of electronic medical record systems
• Solid knowledge of the Medicare market
• Knowledge base of clinical standards of care, preventive health, and Stars measures
• Proven solid problem-solving skills
• Proven medical/clinical background
• Proven solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
• Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills

*All employees working remotely 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 - $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.