The Physician Business Manager is responsible for developing, maintaining, and servicing a high quality, marketable, and satisfied provider network within an assigned geographic area. Key responsibilities include recruitment and contracting, education, and servicing of assigned providers. The Physician Business Manager helps assigned providers operate successfully within our healthcare delivery model by providing strategic planning and tools to meet goals. This position is expected to build and sustain strong working relationships with cross-functional departments, vendors, local sales, and assigned providers. The Physician Business Manager is accountable for overall performance and profitability for their assigned groups, as well as ownership and oversight to provide redirection as appropriate.
This position is remote within the Abilene, TX area. The Physician Business Manager will be traveling 50% of the time within a 50 mile radius of the Abilene area.
Primary Responsibilities:
Educate providers to ensure they have the tools they need to meet quality, risk adjustment, growth (as appropriate), and total medical cost goals per business development plans
Ensure providers have in depth understanding of WellMed Model of Care to include, but not limited to, contractual obligations, program incentives, and patient care best practices
Conduct detailed analysis of various reports by tracking and trending data to develop a strategic plan to ensure performance goals are achieved
Ensure the overall strategic plan incorporates interventions with internal departments or subject matter experts, external vendors, and others as needed
Participate in creation and execution of a local network development plan to assure network adequacy as needed
Work at the direction of their assigned leader to recruit / contract providers ensuring network adequacy
Conduct new provider orientations and ongoing education to providers and their staffs on healthcare delivery products, health plan partnerships, processes, and compensation arrangements
Maintain open communication with providers to include solutions for resolution and closure on health plan issues related to credentialing, claims, eligibility, disease management, utilization management, quality and risk adjustment programs
Conduct provider meetings to share and discuss economic data, troubleshoot for issue resolution, and implement an escalation process for discrepancies
Collaborate with provider groups to develop, execute, and monitor performance and patient outcomes improvement plans
Collaborate with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs
Handle or ensure appropriate scheduling, agenda, materials, location, meals, and minutes of provider meetings as needed
Collaborate with contracting team to ensure provider data is correct and Provider directories include any needed updates
Complete Practitioner Data Forms and Provider Change Forms as needed
Represent WellMed / UHG by holding company sponsored Provider events (Summits, Learning Sessions)
Provide information and participate in management meetings as requested
Regularly meet with cross-functional team to create, revise, and adjust strategy for assigned Provider Groups to meet overall performance goals
Provider support to maintain and develop ongoing value related to the WellMed Value Proposition
Introduce and advocate company resources to facilitate practice optimization
Identify at risk situations and develop a plan for escalation and corrective action