Optum Pbm Jobs (NOW HIRING)

WellMed, part of the Optum family of businesses, is seeking a Senior Practice Support Specialist to join our team in Florida. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

The Sr. Practice Support Specialist (PSS) serves as a clinical liaison between contracted primary care practices and WellMed contracted clinical operations. This role is designed to drive value-based care performance and reduce avoidable utilization through proactive patient outreach, coordinated clinical interventions, and improved  provider engagement. The PSS supports practices in managing high-risk patients and implementing population health strategies aligned with organizational priorities. This role reports to the Provider Relations Leader and works in a matrixed leadership environment. Clinical activities will occur under the direction of the WellMed Senior Medical Director and in accordance with Company protocols, established nursing practice standards, and the relevant state regulatory requirements. The role is field based with an expected travel requirement of 75-85% to contracted provider offices.

Primary Responsibilities:

• Care & Value Optimization
  • Manage patient census across assigned practices, focusing on high-risk and high cost cohorts
  • Monitor and influence key utilization metrics: ER visits, Admits/K, Readmits/K, SNF/ASC/hospital usage, and palliative care engagement
  • Serve as a liaison between PCPs, hospitalists, specialists, and care management programs to ensure coordinated care delivery
  • Support practices in implementing contingency plans for high-risk patients (HF, COPD), including documentation of advanced directives and care bundle elements
  • Conduct weekly touchpoints with the medical director dyad partner to review admissions and determine escalations to contracted providers
  • In partnership with PBM and Medical Director team, analyze utilization and performance data to identify trends and root causes
  • Develop action plans aligned with market goals (quality, cost, coding)
  • Produce and share scheduled/ad-hoc reports on key metrics
• Patient Coordination & Engagement
  • Ensure monthly visits for Band 5 and other high-risk cohorts per prioritization list.
  • Facilitate timely follow-up for hospital discharges and transitions of care
  • Conduct weekly 'tuck-in calls' to high-risk members
  • Provide education on call us first
  • Assist practices in managing high-cost patients and ensuring follow-up on screenings and lab measures
• Referral & Specialist Strategy

  • Support referral management aligned with preferred specialist strategy

  • Facilitate Tier 1 Cardiology/HF clinic referrals and support optimization of guideline directed medical therapy (GDMT)
• Quality & Risk Adjustment Support
  • Provide education and baseline support for risk adjustment documentation before coder SME engagement
  • Drive timely closure of care gaps (medication adherence, preventive screenings, HEDIS/STAR measures)
  • Assist practices in understanding and applying QRA strategies

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors' offices. At WellMed our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000 primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000 older adults. Together, we're making health care work better for everyone.

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:

• Associates Degree in Nursing
• Current, unrestricted RN license required, specific to the state of 
  employment or able to obtain compact license within 30 days of hire
• 4 years in any combination of provider relations, network 
  management, care management, and/or clinical operations.
• Medicare Advantage, HEDIS, STAR, CMS reimbursement models, 
  risk adjustment
• Proven solid analytics, communication, relationship-building, and proficiency in Microsoft Office
• Travel: Ability to travel extensively (up to 75-85%) and possess a valid drivers license issued by the state of practice

Preferred Qualifications:

• Bachelor's degree in Business or Healthcare Administration
• CPC Certification
• Experience in value-based care or population health management

Performance Metrics

• Reduction in Admits/K and Readmits/K
• Increased engagement of high-risk cohorts and care initiatives
• Timely closure of care gaps and improved documentation accuracy
• Provider satisfaction and resolution of escalated issues

Physical & Mental Requirements

• Ability to sit/stand for extended periods; operate office equipment.
• Ability to drive and travel extensively.
• Ability to lift up to 25 lbs.
• Ability to comprehend instructions and apply logical reasoning

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.

OptumCare 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.