Optum · 15 hours ago
Senior Provider Engagement Specialist - Remote
United States
Full-time
Remote
Senior Level
$73K/yr - $130K/yr
5+ years expOptum is focused on innovating the future of health care, aiming to integrate health programs across the continuum of care. The Senior Provider Engagement Specialist is responsible for enhancing the quality and economic performance of physician practices in Kansas and Missouri by developing high-performing provider networks and maintaining strong relationships with stakeholders.
EducationHealth CareMedicalPharmaceutical
Responsibilities
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
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
Qualification
Required
5+ years of experience in a related medical field or health plan setting (network management, contracting and/or recruitment, or provider relations)
Knowledge of state and federal laws relating to Medicare
Solid working knowledge of Medicare health care operations including HEDIS, CMS reimbursement models, and Medicare Advantage
Proficiency in Microsoft Word, Excel and PowerPoint
Ability to travel 25% of the time within WI
Driver's License and access to reliable transportation
Preferred
Understanding of IPAs, Clinically Integrated Networks, Medicare Shared Savings Programs, capitation/value-based contracting, and narrow networks
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 employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Benefits
Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Company
Optum
Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Daniel Castillo
Chief Executive Officer, Optum Care Delivery
J
Jay Green
Chief Financial Officer
Recent News
2025-11-29
2025-11-19
2025-11-07
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