Physician Business Mgr (Contracting / Provider Rel) - Tyler, TX (883007)
About the Job
Position Description Note: The successful candidate will live in Tyler, TX or in the Upper East Texas area.The Physician Business Manager with WellMed is responsible for developing, maintaining, and servicing a high quality, marketable, and satisfied provider network within an assigned geographic area. Key responsibilities include recruitment and contracting, education, and servicing of assigned providers. The Physician Business Manager helps assigned providers operate successfully within our healthcare delivery model by providing strategic planning and tools to meet goals. This position is expected to build and sustain strong working relationships with cross functional departments, vendors, local sales, and assigned providers. The Physician Business Manager is accountable for overall performance and profitability for their assigned groups, as well as ownership and oversight to provide redirection as appropriate. Primary Responsibilities:Educate providers to ensure that they have the tools they need to meet quality, risk adjustment, growth (as appropriate), and total medical cost goals per business development plansEnsure providers have in-depth understanding of WellMed Model of Care to include, but not limited to, contractual obligations, program incentives, and patient care best practicesConduct detailed analysis of various reports by tracking and trending data to develop a strategic plan to ensure performance goals are achievedEnsure the overall strategic plan incorporates interventions with internal departments or subject matter experts, external vendors, and others, as neededParticipate in creation and execution of a local network development plan to assure network adequacy as neededWork at the direction of your assigned leader to recruit/contract providers, ensuring network adequacyConduct new provider orientations and ongoing education to providers and their staffs on healthcare delivery products, health plan partnerships, processes, and compensation arrangementsMaintain open communication with providers to include solutions for resolution and closure on health plan issues related to credentialing, claims, eligibility, disease management, utilization management, quality, and risk adjustment programsConduct provider meetings to share and discuss economic data, troubleshoot for issue resolution, and implement an escalation process for discrepanciesCollaborate with provider groups to develop, execute, and monitor performance and patient outcomes improvement plansCollaborate with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPsHandle or ensure appropriate scheduling, agenda, materials, location, meals, and minutes of provider meetings as neededCollaborate with contracting team to ensure provider data is correct and provider directories include any needed updatesComplete Practitioner Data Forms and Provider Change Forms as neededRepresent WellMed / UHG by holding company sponsored provider events (summits, learning sessions)Provide information and participate in management meetings as requestedRegularly meet with cross functional team to create, revise, and adjust strategy for assigned provider groups to meet overall performance goalsProvide support to maintain and develop ongoing value related to the WellMed Value PropositionIntroduce and advocate company resources to facilitate practice optimizationYou’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.