Job Description

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

The Practice Management Specialist must demonstrate strong clinical and analytic skills, strong oral and written communication skills and must be comfortable working closely with senior leaders at high volume facilities/groups and/or providers. The Practice Specialist will be responsible for the development of relationships with providers, groups and facilities as well as other outpatient behavioral health providers. The Practice Specialist will monitor their clinical effectiveness and efficiency, as well as compliance with contractual obligations. This Specialist will work closely with Clinical Operations, Affordability, Program and Network Integrity and Network Management teams to affect desired outcomes with as it relates to treatment for our membership.

The Specialist will partner with outpatient providers and groups in the following manner:

Those providers and groups that operate outside of typical practice or billing patterns will be subject to a specific set of interventions. The Practice Specialist's role with these providers and groups will be to coordinate a strategic effort that includes Clinical Operations, Affordability, Program and Network Integrity and Network Management with the goal of designing and delivering interventions aimed at improving performance and outcomes.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

* Interface with senior leaders (e.g., CEO) at high volume provider practices and/or groups or directly with providers as indicated
* Communicate with providers and groups to initiate appropriate interventions focused on improvement of clinical outcomes and efficiency, as well as compliance with care advocacy processes and contractual obligations
* Support those high performing providers and groups such that performance remains at a high level.
* Identify outliers through analysis of clinical outcomes data, utilization/claims data, complaints, and compliance with care advocacy protocols
* Measure improvement of program/provider performance over time
* Monitor and report effectiveness of interventions
* Modify interventions as appropriate
* Initiate and monitor Performance Improvement Plans (PIPs) as appropriate to affect performance
* Interface with other OHBS departments including Clinical Operations, Affordability, Program and Network Integrity and Network Management

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:

* Licensed Master's degree-level clinician in Psychology, Social Work, Counseling or Marriage or Family Counseling, Licensed Ph.D. level Psychologist, or Registered Nurse
* Licenses must be independent, active and unrestricted
* 3+ years of Managed Care and/or Utilization Review experience in a Managed Care setting
* Strong knowledge of CPT/HCPCS codes
* Strong analytical skills with knowledge of or willingness to learn analytics software such as Microsoft Excel
* Strong communication skills, written and verbal, including ability to communicate effectively with and present to various levels of leadership
* Strong analytical skills with knowledge of or willingness to use Microsoft Excel on a frequent basis
* Dedicated space for home office set up and access to high speed internet services

Preferred Qualifications:

* Direct clinical experience (Post Licensure)
* Knowledge of public sector benefits, i.e., Medicaid
* Ability to balance contractual and clinical considerations
* Capacity to provide solutions for non - standard and/or complex issues solutions
* Excellent time management and prioritization skills
* Ability to establish and maintain strategic relationships with senior leadership teams

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy

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: Practice Management Specialist, Outpatient, Behavioral Health, LMFT, LPC, LP, LCSW, LMHC, RN, Social Worker, Therapist, Counselor, Case Manager, Case Worker, Care Advocate, Quality, Data Analysis, HEDIS, Work From Home, Telecommute