For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life’s best work.(sm)
The Behavioral Health 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 providers/groups/facilities. They will be responsible for the development of relationships with Community Mental Health Centers (CMHCs), groups, and facilities as well as other outpatient behavioral health entities. They will monitor their clinical effectiveness and efficiency, as well as compliance with contractual obligations. This Practice Specialist will work closely with Care Advocacy Operations, Affordability and Network Management teams to affect desired outcomes with facilities / programs as it relates primarily to treatment for our public sector membership.
The Practice Specialist will partner with outpatient providers/groups/facilities that operate outside of typical practice or billing patterns which will be subject to a specific set of interventions. The Practice Specialist’s role with these providers / groups / facilities 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 addressing outlier practice patterns, while improving provider performance, quality and clinical outcomes. These interventions may include, but are not limited to, clinical audits and the development of performance improvement plans.
**If you live in Texas, you will have the flexibility to telecommute* as you take on some tough challenges.
- Interface with senior leaders (e.g., CEO) at high volume facilities / providers/ groups
- Communicate with facilities / providers / groups to initiate appropriate interventions focused on improvement of clinical outcomes and efficiency, improved quality of care, and appropriate billing and practice patterns
- Support those high performing providers / groups / facilities such that performance remains at a high level
- Identify outliers through analysis of clinical outcomes data, utilization / claims data
- Conduct program audits and provide feedback results
- Measure improvement of program performance over time
- Modify interventions as appropriate
- Initiate and monitor Performance Improvement Plans (PIPs) as appropriate to affect performance
- Interface with other Optum departments including Care Advocacy, Affordability, Clinical Network Services, Program and Network Integrity, Legal, 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 OR a Licensed Ph.D. level Psychologist, OR an RN with behavioral health experience
- License must be active and unrestricted to practice at the independent level
- 3+ years of utilization management experience in a managed care setting
- Direct provider facing experience
- Experience auditing medical records and reviewing results
- Knowledge of CPT / HCPCS codes
- Experience in interpreting and utilizing clinical data analytics in healthcare and use of that data to drive change
- Solid communication skills, written and verbal, including ability to communicate effectively with and present to various levels of leadership
- Solid 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
- 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.
- 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: LMFT, LPC, LP, LCSW, LMHC, RN, Social Worker, Therapist, Counselor, Case Manager, Case Worker, Care Advocate, quality, data analysis, HEDIS, Work from home, Telecommute, Telecommuter, Texas, TX