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The Practice Performance Consultant is responsible for program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy. The person in this role is expected to work directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results. The person will review charts (paper and electronic - EMR), look for gaps in care, perform telephonic assessments, help coordinate doctor appointments, make follow - up calls to members after appointments, and assist our members in overall wellness and prevention. Work is primarily performed at physician practices on a daily basis.
- Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members
- Execute applicable provider incentive programs for health plan
- Establish positive, long - term, consultative relationships with physicians, medical groups, IPAs and ACOs
- Develop comprehensive, provider - specific plans to increase their HEDIS performance and improve their outcomes
- Provide ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
- Act as lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation.
- Training will include Stars measures (HEDIS / CAHPS / HOS / med adherence), and Optum program administration, use of plan tools, reports and systems
- Coordinate and lead Stars - specific JOC meetings with provider groups with regular frequency to drive continual process improvement and achieve goals
- Provide reporting to health plan leadership on progress of overall performance, HQPAFs, gap closure, and use of virtual administrative resource
- Facilitate / lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
- Provide suggestions and feedback to Optum and health plan
- Work collaboratively with health plan market leads to make providers aware of Plan - sponsored initiatives designed to assist and empower members in closing gaps
Includes up to 75% local travel