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.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Interface with senior leaders (e.g., CEO) at high volume facilities/groups or directly with providers, as indicated
- Communicate 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 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 Corrective Action Plans (CAPs) as appropriate to affect performance
- Interface with other OHBS departments including Care Advocacy, Affordability, Clinical Network Services, Program and Network Integrity, and Quality Improvement
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.
- 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 experience
- Licenses and certifications must be active and unrestricted
- Board 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 Analysis
- Solid computer skills at the intermediate level, proficiency with MS Office
- Dedicated space for home office set up and access to high speed internet services
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employee must comply with any state and local masking orders.
- Post-licensure direct clinical experience
- Knowledge of the public sector, i.e., Medicaid
- Strong analytical skills with knowledge of or willingness to learn analytics software such as Microsoft Excel
- Strong 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 teams
- Excellent 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)
*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: 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