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Senior Practice Advocate

Company: Optum
Location: Tacoma
Posted on: October 18, 2020

Job Description:

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Serves as a single-point-of-contact to the Network and is an accountable owner who is responsive to Network provider and practice needs

Facilitates the transition of new clinics from onboarding from the network development team into daily operations and ongoing quality performance improvement

Facilitates practice engagement in the following areas: Comprehensive Health Assessment Programs (CHAPs) Performance & Compliance

Action Plans for Clinical Quality Performance Improvement

Education of Utilization and Care Management Initiatives

Troubleshooting of claims and prior authorization issues

Education of the Physician Quality Incentive Program (PQIP)

Builds continuous and collaborative relationships with NPN providers and their office staff

Adheres to a scheduled cadence for touchpoints and ensures that agreed upon agenda is followed and action items are documented and tracked including: Minimum of once a month touch points with all assigned primary care practices to include discussions on performance reporting with practice staff and/or providers

Facilitation, including the compilation of presentation materials and scheduling, for quarterly Joint Operating Committees (JOCs)

Works closely with all functional areas within NPN to deliver clear communications, education, and exemplary service across the NPN Network

Works across all functional areas to appropriately research, triage, and escalate complex queries from clinics in need of increased attention to reach a point of resolution

Responsible for coordinating/co-developing provider orientations and onboarding for new Network providers

Monitors performance of assigned primary care providers (PCPs), identifies low performing PCPs, and works with teammates and NPN Leadership to develop action plan/s for specific metrics needing improvement Works with the provider and practice office staff to effectuate action plan and monitors progress, intervenes, and escalates issues or concerns as appropriate

Knowledgeable about the various quality measures and improvement programs, and educates providers and practices on how to improve performance Supports and assists practices to earn the maximum bonus potential related to CHAPs, clinical quality, and patient satisfaction measures

Documents, tracks, triages, and follows and/or closes issues in a timely manner. Expected response time is within one (1) business day for provider issues to include updating providers and their office staff regularly until there is resolution Proactive approach to identify issues and determining root cause/s so issues can be resolved timely and completely; escalates issues as appropriate to Director or key Leadership staff

Represents NPN at community and other provider meetings

Regularly collects and reports feedback and recommendations from practices regarding potential opportunities Maintains awareness of providers interested in further engagement with NPN for new business opportunities, including market insights that would impact the Network and NPN

Maintains, utilizes, protects, and discloses NPN patient’s protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPPA) standards

Performs other duties as assigned

KNOWLEDGE, SKILLS AND ABILITIES General knowledge of Medicare and Medicaid risk-based contracts

Knowledgeable in the various quality measures, incentive, and provider relations offerings

Ability to judge appropriate information to be conveyed to different levels of management

Strong interpersonal skills with the ability to maintain collaborative working relationships at all levels of the organization

Ability to prioritize and organize work to meet multiple deadlines and quickly re-prioritize when necessary

Excellent verbal, written and presentation skills

Promote a positive “Can Do” attitude which inspires other team members

Ability to take initiative, handle complex situations, ask questions and escalate issues as may be required

Excellent computer skills, including MS Office Suite with the ability to learn and apply new software

Ability to work accurately with detail

Ability to obtain and retain knowledge of cross functional resources within the organization

Ability to work effective under deadlines, frequent interruptions, and changing priorities

MINIMUM QUALIFICATIONS Education:           Bachelor’s degree in Business Administration or related field or equivalent work experience preferred (Master’s degree preferred)

Experience:         Minimum of 3 years working directly within a Health Care and/or Managed Health Care (HMO) field, including provider relations or related experience in a physician’s practice or clinic environment, and quality improvement

Certification/License: Current driver’s license

Keywords: Optum, Tacoma , Senior Practice Advocate, Other , Tacoma, Washington

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