Remote Utilization Review Jobs in Wichita, KS (NOW HIRING)

REMOTE IN WICHITA, KS

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. 

The Senior Account Manager has geographic responsibility for the quality and economic performance of the physician practice with the goal of developing a high performing provider network within the State of Kansas. This includes analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning.

The Senior Account Manager will develop and sustain a solid day-to-day relationship with stakeholders, the physician and office staff to effectively implement the business solutions developed by the Client Services leadership team. They are accountable for overall performance and profitability for their assigned groups as well as ownership and oversight to provide redirection as appropriate and approved. The responsibilities of this position include capabilities in the following areas: strategic planning and analysis; understanding of HEDIS, Star ratings, accurate documentation and coding; highly developed communication skills; and the ability to develop clear action plans and drive process.

Schedule: Monday - Friday, 8am - 5pm

Location: This role is remote in Wichita, KS and requires the ability to travel 25% of the time.

If you are located in Wichita, KS or the surrounding cities, you will have the flexibility to work remotely* as you take on some tough challenges.

Essential Job Functions:

• Educate providers to ensure they have the tools needed to meet quality, coding and documentation, and total medical cost goals per business development plans
• Develops strategies and create action plans that align provider pools and groups with company initiatives, goals, quality outcomes, program incentives, and patient care best practices
• Drive processes and improvement initiatives that directly impact revenue, HEDIS/STAR measures and quality metrics, coding and documentation process and educational improvements
• Conduct new provider orientations and ongoing education to provider and their staff on healthcare delivery products, health plan partnerships, processes, and tools
• 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
• Conduct provider meetings to share and discuss reporting data and analysis, issue resolution needs, implement escalation processes for discrepancies, and handles or ensures appropriate scheduling, agenda, and materials
• Collaborates with internal clinical services teams, alongside operational leaders, to monitor utilization trends 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 medical director, operations, and cross functional teams, and other 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

Primary Responsibilities:

• Solid analytical skills required to support, compile and report key information
• Drive processes that directly impact Revenue, HEDIS/STAR measures and Quality Metrics, and total cost of care, as appropriate
• 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 performance of related metrics and goals
• Collaborate with internal leaders to foster teamwork and build consistency throughout the market
• Serves as a liaison to the health plan and all customers
• Requires solid 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

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:

• 3 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 state and federal laws relating to Medicare
• 2 years of experience with Medicare health care operations including HEDIS, CMS reimbursement models, and Medicare Advantage
• 1 years of experience with IPAs, Clinically Integrated Networks, Medicare Shared Savings Programs, capitation/value-based contracting, and narrow networks or similar related experience
• Advanced level of proficiency in Microsoft Word, Excel and PowerPoint
• Ability to travel 25% of the time
• Access to reliable transportation & valid US driver's license

Preferred Qualifications:

• Demonstrated ability to act as a mentor to others
• Demonstrated ability to communicate and facilitate strategic meetings with groups of all sizes
• Demonstrated ability to work independently, use good judgment and decision-making process
• Demonstrated ability to adopt quickly to change in an ever-changing environment
• Proven solid business acumen, analytical, critical thinking and persuasion skills

*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.

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