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 as well as provider groups and individual providers. The Facility Practice Specialist will be responsible for the development of relationships with Autism and Applied Behavioral Analysis (ABA) providers as well as other behavioral health providers, i.e., BCBAs, as appropriate. The Facility Practice Specialist will monitor their clinical effectiveness and efficiency, as well as compliance with contractual obligations. This Specialist will work closely with Care Advocacy Operations, Affordability and Network Management teams to affect desired outcomes with facilities/programs/providers as it relates to treatment for our membership. The Specialist will partner with INN and OON Autism and ABA providers and other providers, i.e., BCBAs, as appropriate in the following manner: Those facilities and/or groups/providers that operate outside of typical practice or billing patterns will be subject to a specific set of interventions. The Practice Management Specialist's role with these facilities/providers will be to coordinate a strategic effort that includes Clinical Operations, Network Services, Program and Network Integrity, and Affordability with the goal of designing and delivering interventions aimed at improving performance and outcomes. Primary Responsibilities:Interface with senior leaders (e.g., CEO) at high volume facilities/groups or directly with providers, as indicatedCommunicate with facilities/groups/providers 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 facilities and providers such that performance remains at a high levelIdentify outliers through analysis of clinical outcomes data, utilization/claims data, complaints, and compliance with care advocacy protocolsMeasure improvement of program/provider performance over timeMonitor and report effectiveness of interventionsModify interventions as appropriateInitiate and monitor Corrective Action Plans (CAPs) as appropriate to affect performanceInterface with other OHBS departments including Care Advocacy, Affordability, Clinical Network Services, Program and Network Integrity, and Quality Improvement
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 with Behavioral Health experienceLicenses and certifications must be active and unrestricted in state of residenceBoard Certified Behavioral Analyst Certification (BCBA)3+ years of Managed Care and/or Utilization Review experience in a Managed Care setting with experience working with Autism and Applied Behavioral AnalysisSolid computer skills at the intermediate level, proficiency with MS OfficeDedicated space for home office set up and access to high speed internet services Access to reliable transportation that will enable you to travel to provider locations within a designated area (up to 25%)Preferred Qualifications:Post-licensure direct clinical experienceKnowledge of the public sector, i.e., Medicaid Strong analytical skills with knowledge of or willingness to learn analytics software such as Microsoft ExcelStrong communication skills, written and verbal Ability to balance contractual and clinical considerations Ability to work in a self - directed manner, seeking guidance on only the most complex tasks 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 facilities senior leadership teamsExcellent time management and prioritization skills 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) 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: LMFT, IMFT, LICSW, LISW, LCSW, LP, LPC, LCPC, LPCC, RN, Social Worker, Therapist, Counselor, Case Manager, Case Worker, Care Advocate, quality, HEDIS, Autism, ABA, BCBA, Work from home, Telecommute
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.